Healthcare Provider Details

I. General information

NPI: 1104737295
Provider Name (Legal Business Name): JUDI RENA STAUFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 SOUTH PATTERSON ST.
CAREY OH
43316
US

IV. Provider business mailing address

19999 TOWNSHIP ROAD 66
ARLINGTON OH
45814-9787
US

V. Phone/Fax

Practice location:
  • Phone: 419-957-9670
  • Fax:
Mailing address:
  • Phone: 419-957-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: