Provider Demographics
NPI:1003914896
Name:STAUFFER, TONDA MARIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:TONDA
Middle Name:MARIE
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TONDA
Other - Middle Name:MARIE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 MEDICAL PARK
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-242-4660
Mailing Address - Fax:304-242-6430
Practice Address - Street 1:30 MEDICAL PARK
Practice Address - Street 2:SUITE 230
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-242-4660
Practice Address - Fax:304-242-6430
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV397363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0081009Medicaid