Healthcare Provider Details

I. General information

NPI: 1285029702
Provider Name (Legal Business Name): THERESA R STAUFFER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 S 2520 E
SLC UT
84109-2521
US

IV. Provider business mailing address

2940 S 2520 E
SLC UT
84109-2521
US

V. Phone/Fax

Practice location:
  • Phone: 801-671-8116
  • Fax:
Mailing address:
  • Phone: 801-671-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number113043-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number113043-5701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: