Basic Information
Provider Information
NPI: 1003005034
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STAGGERS
FirstName: MISTI
MiddleName: D.
NamePrefix:  
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 120 MCMILLEN DR
Address2:  
City: NEWARK
State: OH
PostalCode: 430551809
CountryCode: US
TelephoneNumber: 7403487935
FaxNumber: 7403487936
Practice Location
Address1: 120 MCMILLEN DR
Address2:  
City: NEWARK
State: OH
PostalCode: 430551809
CountryCode: US
TelephoneNumber: 7403487935
FaxNumber: 7403487936
Other Information
ProviderEnumerationDate: 10/16/2007
LastUpdateDate: 10/16/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
364SG0600XNP07950OHY Physician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology

No ID Information.


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