Basic Information
| Provider Information | |||||||||
| NPI: | 1710106703 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAUFFER | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HARPST ST | ||||||||
| Address2: | HUMBOLDT STATE UNIVERSITY | ||||||||
| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955218222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078265029 | ||||||||
| FaxNumber: | 7078265042 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HARPST ST | ||||||||
| Address2: | HUMBOLDT STATE UNIVERSITY | ||||||||
| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955218222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078265029 | ||||||||
| FaxNumber: | 7078265042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G50694 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.