Provider Demographics
NPI:1932480423
Name:STAVER, ANDREAS MICHAEL (RN)
Entity Type:Individual
Prefix:
First Name:ANDREAS
Middle Name:MICHAEL
Last Name:STAVER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LYNX LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9001
Mailing Address - Country:US
Mailing Address - Phone:319-471-3369
Mailing Address - Fax:
Practice Address - Street 1:110 LYNX LN
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9001
Practice Address - Country:US
Practice Address - Phone:319-471-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA117890163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic