Provider Demographics
NPI:1073555090
Name:STAGE, LINDA DIANE (STNA)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:DIANE
Last Name:STAGE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 PERRY RDG
Mailing Address - Street 2:
Mailing Address - City:NELSONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45764-9542
Mailing Address - Country:US
Mailing Address - Phone:740-593-8114
Mailing Address - Fax:
Practice Address - Street 1:4145 PERRY RDG
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764-9542
Practice Address - Country:US
Practice Address - Phone:740-593-8114
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH372602481292376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2223829Medicaid