1710959820 NPI number — STEPHANIE A STAATS ARNP

Table of content: STEPHANIE A STAATS ARNP (NPI 1710959820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710959820 NPI number — STEPHANIE A STAATS ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAATS
Provider First Name:
STEPHANIE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSENHAGEN
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710959820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 529
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHENEY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67025-0529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-542-3000
Provider Business Mailing Address Fax Number:
316-542-3001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 N MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHENEY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-542-3000
Provider Business Practice Location Address Fax Number:
316-542-3001
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  44781 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100349460D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00652247 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com