Provider Demographics
NPI:1568711604
Name:STOVICH, CLARAN
Entity Type:Individual
Prefix:
First Name:CLARAN
Middle Name:
Last Name:STOVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8216 ANNA AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-1383
Mailing Address - Country:US
Mailing Address - Phone:262-895-2812
Mailing Address - Fax:
Practice Address - Street 1:8216 ANNA AVE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-1383
Practice Address - Country:US
Practice Address - Phone:262-895-2812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI303214-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse