Provider Demographics
NPI:1124795125
Name:STAATS, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:STAATS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BUSH RUN RD
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25244
Mailing Address - Country:US
Mailing Address - Phone:304-372-6926
Mailing Address - Fax:
Practice Address - Street 1:85 BRUSH RUN RD
Practice Address - Street 2:
Practice Address - City:GAY
Practice Address - State:WV
Practice Address - Zip Code:25244-9081
Practice Address - Country:US
Practice Address - Phone:304-372-6926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant