Provider Demographics
NPI:1184707762
Name:STUMBAUGH, KATHY ANN (RN RNFA)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ANN
Last Name:STUMBAUGH
Suffix:
Gender:F
Credentials:RN RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 UPTON ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062
Mailing Address - Country:US
Mailing Address - Phone:650-367-9342
Mailing Address - Fax:
Practice Address - Street 1:170 ALAMEDA DE LAS POLGAS
Practice Address - Street 2:SEQUOIA HOSPITAL
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062
Practice Address - Country:US
Practice Address - Phone:650-369-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236330163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant