Provider Demographics
NPI:1881149631
Name:STAIRS, AGNES MARIANN (PHD)
Entity type:Individual
Prefix:DR
First Name:AGNES
Middle Name:MARIANN
Last Name:STAIRS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:536 N 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3102
Mailing Address - Country:US
Mailing Address - Phone:402-660-7143
Mailing Address - Fax:
Practice Address - Street 1:SPECIALTY SERVICES PAVILION RM 5014
Practice Address - Street 2:984185 NEBRASKA MEDICAL CENTER
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-4185
Practice Address - Country:US
Practice Address - Phone:402-559-5031
Practice Address - Fax:402-559-9592
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical