Provider Demographics
NPI:1306433958
Name:STOVER, MINDY
Entity type:Individual
Prefix:
First Name:MINDY
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 1:6184 BROOKMEADE CIR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9084
Mailing Address - Country:US
Mailing Address - Phone:614-374-6618
Mailing Address - Fax:
Practice Address - Street 1:222 CAVANAUGH DR
Practice Address - Street 2:
Practice Address - City:COMMERCIAL POINT
Practice Address - State:OH
Practice Address - Zip Code:43116-9752
Practice Address - Country:US
Practice Address - Phone:614-374-6618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide