Provider Demographics
NPI:1518096932
Name:SHOVER, SHEILA ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:ANN
Last Name:SHOVER
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:PO BOX 539
Mailing Address - Street 2:99 CONVERSE ST
Mailing Address - City:CHAUNCEY
Mailing Address - State:OH
Mailing Address - Zip Code:45719-0539
Mailing Address - Country:US
Mailing Address - Phone:843-323-9944
Mailing Address - Fax:530-658-6112
Practice Address - Street 1:99 CONVERSE ST.
Practice Address - Street 2:
Practice Address - City:CHAUNCEY
Practice Address - State:OH
Practice Address - Zip Code:45719
Practice Address - Country:US
Practice Address - Phone:843-323-9944
Practice Address - Fax:530-658-6112
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.115311-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2470393Medicaid