Provider Demographics
NPI:1255169140
Name:CANTU, STACI FELIZ
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:FELIZ
Last Name:CANTU
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 1:129 RHETT AVE
Mailing Address - Street 2:
Mailing Address - City:ELM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72762-9007
Mailing Address - Country:US
Mailing Address - Phone:479-409-7934
Mailing Address - Fax:
Practice Address - Street 1:1585 NEIL AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1216
Practice Address - Country:US
Practice Address - Phone:614-292-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR089260163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse