Provider Demographics
NPI:1013724269
Name:STAAB, DOLLY
Entity type:Individual
Prefix:
First Name:DOLLY
Middle Name:
Last Name:STAAB
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 1:107 HIGH ST
Mailing Address - Street 2:PO BOX 79
Mailing Address - City:ODELL
Mailing Address - State:NE
Mailing Address - Zip Code:68415-0079
Mailing Address - Country:US
Mailing Address - Phone:402-209-1447
Mailing Address - Fax:
Practice Address - Street 1:107 HIGH ST
Practice Address - Street 2:PO BOX 79
Practice Address - City:ODELL
Practice Address - State:NE
Practice Address - Zip Code:68415-0079
Practice Address - Country:US
Practice Address - Phone:402-209-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant