Healthcare Provider Details

I. General information

NPI: 1720880164
Provider Name (Legal Business Name): SHANA MICHELE STAAB RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 1ST AVE SE
CEDAR RAPIDS IA
52402-5003
US

IV. Provider business mailing address

1509 RIDGE TOP DR NE
SWISHER IA
52338-9421
US

V. Phone/Fax

Practice location:
  • Phone: 319-558-4800
  • Fax:
Mailing address:
  • Phone: 319-533-7135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number089438
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number089438
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: