Basic Information
| Provider Information | |||||||||
| NPI: | 1689109407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STATEN | ||||||||
| FirstName: | THERESA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 724 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451231052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374036568 | ||||||||
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| Practice Location | |||||||||
| Address1: | 272 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456019031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407797500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2017 | ||||||||
| LastUpdateDate: | 04/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN.334661 | OH | N | Nursing Service Providers | Registered Nurse | 364SG0600X | APRN.CNS.019335 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Gerontology |
No ID Information.