Provider Demographics
NPI:1346297744
Name:STAUBACH, ROBYN M (NP)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:M
Last Name:STAUBACH
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 1:81 DARTMOUTH ST APT 304
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-3531
Mailing Address - Country:US
Mailing Address - Phone:413-281-6051
Mailing Address - Fax:
Practice Address - Street 1:5352 W CORRAL PL
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-2772
Practice Address - Country:US
Practice Address - Phone:413-281-5061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2114OtherBLUE CROSS
MANP2114OtherBLUE CROSS
MAS94204Medicare UPIN