Provider Demographics
NPI:1902995574
Name:STAUFFER, CHRISTINE ANN (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ANN
Other - Last Name:MACGILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 BROADACRES DR STE 445
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3156
Mailing Address - Country:US
Mailing Address - Phone:303-725-0111
Mailing Address - Fax:973-661-8333
Practice Address - Street 1:2479 S CLERMONT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6588
Practice Address - Country:US
Practice Address - Phone:973-661-8300
Practice Address - Fax:973-661-8333
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO98260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA98620OtherSTATE LICENSE