Provider Demographics
NPI:1265543201
Name:STAUFFER, JENDA M (CNM)
Entity type:Individual
Prefix:MS
First Name:JENDA
Middle Name:M
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11623 ARBOR ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2981
Mailing Address - Country:US
Mailing Address - Phone:402-884-7533
Mailing Address - Fax:402-884-0609
Practice Address - Street 1:11623 ARBOR ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2981
Practice Address - Country:US
Practice Address - Phone:402-884-7533
Practice Address - Fax:402-884-0609
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE120020367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1265543201Medicaid
NE1002548600Medicaid
NE47068731799Medicaid
IA1994749Medicaid
NE10025350400Medicaid
NE1002548600Medicaid
IA1994749Medicaid