Provider Demographics
NPI:1174841720
Name:STAUFFER, JANE MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:MARIE
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3966 NORTHSHORE TRL
Mailing Address - Street 2:
Mailing Address - City:KEWADIN
Mailing Address - State:MI
Mailing Address - Zip Code:49648-8974
Mailing Address - Country:US
Mailing Address - Phone:269-370-1345
Mailing Address - Fax:
Practice Address - Street 1:3147 LOGAN VALLEY RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4772
Practice Address - Country:US
Practice Address - Phone:231-935-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704092456363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health