Provider Demographics
NPI:1386371870
Name:STOVALL, LADONNA
Entity type:Individual
Prefix:
First Name:LADONNA
Middle Name:
Last Name:STOVALL
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 1:1440 CHAMBERS RD STE C
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2270
Mailing Address - Country:US
Mailing Address - Phone:314-405-4802
Mailing Address - Fax:
Practice Address - Street 1:1440 CHAMBERS RD STE C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63135-2270
Practice Address - Country:US
Practice Address - Phone:314-405-4802
Practice Address - Fax:314-696-2284
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant