Healthcare Provider Details

I. General information

NPI: 1447884374
Provider Name (Legal Business Name): MICHELLE STOVER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2020
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COOKS HILL RD STE G
CENTRALIA WA
98531-9162
US

IV. Provider business mailing address

2690 NE KRESKY AVE
CHEHALIS WA
98532-2412
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-3042
  • Fax: 360-736-2967
Mailing address:
  • Phone: 360-330-9595
  • Fax: 360-330-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61074467
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61074467
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60436152
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: