Provider Demographics
NPI:1427695758
Name:STOVER, BETSY SUE (RN)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:SUE
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 1:319 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-4210
Mailing Address - Country:US
Mailing Address - Phone:716-478-4627
Mailing Address - Fax:716-478-4647
Practice Address - Street 1:319 WEST AVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-4210
Practice Address - Country:US
Practice Address - Phone:716-478-4627
Practice Address - Fax:716-478-4647
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY417343163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse