Provider Demographics
NPI:1952952004
Name:STAGIS, CAROL ANN
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:STAGIS
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 1:43 OVERLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-7931
Mailing Address - Country:US
Mailing Address - Phone:860-585-1317
Mailing Address - Fax:
Practice Address - Street 1:43 OVERLOOK AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-7931
Practice Address - Country:US
Practice Address - Phone:860-585-1317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant