Individual
TRACEY LEANN STOVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1947 N FOUNDERS CIR, WICHITA, KS 67206-3548
(316) 613-4600
Mailing address
7702 E OAKMOUNT ST, WICHITA, KS 67226-3527
(316) 260-3330
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
55019
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100408210A
—
KS
01
—
144633
BCBS OF KS
KS
01
—
430066312
RR MEDICARE GROUP CQ2302
—
Enumeration date
06/06/2006
Last updated
03/14/2016
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