Provider Demographics
NPI:1619564093
Name:STAGGS, EMMA JOSEPHINE
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:JOSEPHINE
Last Name:STAGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 N BURGESS HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ELK GARDEN
Mailing Address - State:WV
Mailing Address - Zip Code:26717-9656
Mailing Address - Country:US
Mailing Address - Phone:304-813-4375
Mailing Address - Fax:304-788-6363
Practice Address - Street 1:98 N BURGESS HOLLOW RD
Practice Address - Street 2:
Practice Address - City:ELK GARDEN
Practice Address - State:WV
Practice Address - Zip Code:26717-9656
Practice Address - Country:US
Practice Address - Phone:304-813-4375
Practice Address - Fax:304-788-6363
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant