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General NPI Number Information
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NPI Number | 1184259962
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Entity Type | Individual
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Provider Name | CHARLANN CARROLL STAAB CNP
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Gender | Female
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 10133 N 92ND ST STE 102
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4556
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Country | US
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Telephone | 480-644-6416
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Fax |
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Provider Business Mailing Address
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Address Line | 1146 N MELODY CIR
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City | CHANDLER
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State | AZ
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Zip | 85225-1695
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Country | US
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Telephone | 480-797-9653
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 220405
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 220405
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 220405
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 220405
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License Number State | AZ
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