Provider Demographics
NPI:1851603930
Name:SHOVER, MARY JO (LPN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
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 1:520 11TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-3811
Mailing Address - Country:US
Mailing Address - Phone:319-398-3562
Mailing Address - Fax:319-398-3501
Practice Address - Street 1:909 W MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057
Practice Address - Country:US
Practice Address - Phone:563-927-6700
Practice Address - Fax:319-398-3501
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP10324164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse