Provider Demographics
NPI:1457669285
Name:STOVERN, WENDY LEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:LEE
Last Name:STOVERN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525 BERGSTROM RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MN
Mailing Address - Zip Code:55779-9572
Mailing Address - Country:US
Mailing Address - Phone:218-729-7986
Mailing Address - Fax:
Practice Address - Street 1:6525 BERGSTROM RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MN
Practice Address - Zip Code:55779-9572
Practice Address - Country:US
Practice Address - Phone:218-729-7986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL32367-7164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse