Healthcare Provider Details

I. General information

NPI: 1902995574
Provider Name (Legal Business Name): CHRISTINE ANN STAUFFER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE ANN MACGILLIS

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/12/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2479 S CLERMONT ST
DENVER CO
80222-6588
US

IV. Provider business mailing address

400 BROADACRES DR STE 445
BLOOMFIELD NJ
07003-3156
US

V. Phone/Fax

Practice location:
  • Phone: 973-661-8300
  • Fax: 973-661-8333
Mailing address:
  • Phone: 303-725-0111
  • Fax: 973-661-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number98260
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: