Provider Demographics
NPI:1457751026
Name:STOVER, BRANDY
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:STOVER
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 1:2467 PENEWIT RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:OH
Mailing Address - Zip Code:45370-8778
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2467 PENEWIT RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:OH
Practice Address - Zip Code:45370-8778
Practice Address - Country:US
Practice Address - Phone:937-902-3014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.146934-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse