Provider Demographics
NPI:1407182538
Name:STAUFER, HEATHER MARIE (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:STAUFER
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 1:14032 WALKING STICK WAY
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-7859
Mailing Address - Country:US
Mailing Address - Phone:440-897-0956
Mailing Address - Fax:
Practice Address - Street 1:14032 WALKING STICK WAY
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-7859
Practice Address - Country:US
Practice Address - Phone:440-897-0956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.339805163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse