Provider Demographics
NPI:1124602099
Name:STOUFFER, SUSAN EILEEN (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:EILEEN
Last Name:STOUFFER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-2158
Mailing Address - Country:US
Mailing Address - Phone:724-859-5254
Mailing Address - Fax:
Practice Address - Street 1:300 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2416
Practice Address - Country:US
Practice Address - Phone:724-543-2941
Practice Address - Fax:724-548-8119
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN532637163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse