MEDICARE: ANNETTE LYNN STAUB APRN-CNP

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	363LA2200X	Adult Health Nurse Practitioner	APRN.CNP.02358	OH
2	363L00000X	Nurse Practitioner	APRN.CNP.02358	OH

General Provider Information

NPI Number	:	1801091558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE LYNN STAUB APRN-CNP

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-293-3196
Fax Number	:	614-293-4812

Provider Business Practice Location Address
First Line	:	2121 KENNY RD FL 6
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43210-3100
Country	:	US
Telephone Number	:	614-293-3196
Fax Number	:	614-293-4812

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

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	02/25/2026

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