Provider Demographics
NPI:1164503843
Name:STAUFENBERG, LINDA JILL (RN)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JILL
Last Name:STAUFENBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JILL
Other - Last Name:STAUFENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:6407 NEWGRANGE DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8211
Mailing Address - Country:US
Mailing Address - Phone:614-873-4244
Mailing Address - Fax:
Practice Address - Street 1:5025 ARLINGTON CENTRE BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2959
Practice Address - Country:US
Practice Address - Phone:614-538-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150104364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health