Provider Demographics
NPI:1285029702
Name:STAUFFER, THERESA R (RN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:R
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 S 2520 E
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2521
Mailing Address - Country:US
Mailing Address - Phone:801-671-8116
Mailing Address - Fax:
Practice Address - Street 1:2940 S 2520 E
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84109-2521
Practice Address - Country:US
Practice Address - Phone:801-671-8116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT113043-3102163WI0600X
UT113043-5701227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified