Provider Demographics
NPI:1710959820
Name:STAATS, STEPHANIE A (ARNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:STAATS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:ROSENHAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67025-0529
Mailing Address - Country:US
Mailing Address - Phone:316-542-3000
Mailing Address - Fax:316-542-3001
Practice Address - Street 1:103 N MAIN
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:KS
Practice Address - Zip Code:67025
Practice Address - Country:US
Practice Address - Phone:316-542-3000
Practice Address - Fax:316-542-3001
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100349460DMedicaid
KSP00652247OtherMEDICARE RAILROAD
KS100349460DMedicaid
KS161689Medicare PIN