Provider Demographics
NPI:1033631361
Name:STAUDT, EMILY JOSEPHINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JOSEPHINE
Last Name:STAUDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 BRODY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-1330
Mailing Address - Country:US
Mailing Address - Phone:712-790-4821
Mailing Address - Fax:
Practice Address - Street 1:750 UNIVERSITY ROW
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-1311
Practice Address - Country:US
Practice Address - Phone:608-890-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4054-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant