MEDICARE: MS. SALLYE LOUISE STAUBER DNP, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	200150002NP	OR
2	363LF0000X	Family Nurse Practitioner	852947	NV

General Provider Information

NPI Number	:	1235174806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SALLYE LOUISE STAUBER DNP, FNP-C

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-5250
Country	:	US
Telephone Number	:	615-314-8069
Fax Number	:

Provider Business Practice Location Address
First Line	:	921 W OWENS AVE STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-5405
Country	:	US
Telephone Number	:	252-693-3647
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	02/01/2023

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