Provider Demographics
NPI:1942428073
Name:STOVER, KATHLEEN SOBUS (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:SOBUS
Last Name:STOVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 LITTLE CURRENT DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5643
Mailing Address - Country:US
Mailing Address - Phone:410-757-4282
Mailing Address - Fax:
Practice Address - Street 1:931 BLUE RIDGE DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-5203
Practice Address - Country:US
Practice Address - Phone:410-222-1689
Practice Address - Fax:410-222-1687
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO66678163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4461Medicaid