Provider Demographics
NPI:1366461964
Name:STAAB, WANDA L (CNP CNS)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:L
Last Name:STAAB
Suffix:
Gender:F
Credentials:CNP CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ARCH ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1437
Mailing Address - Country:US
Mailing Address - Phone:330-376-7000
Mailing Address - Fax:330-376-1066
Practice Address - Street 1:95 ARCH ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1437
Practice Address - Country:US
Practice Address - Phone:330-376-7000
Practice Address - Fax:330-376-1066
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06552364SA2200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2599568Medicaid
OHQ54350Medicare UPIN
OHNP20313Medicare PIN