Provider Demographics
NPI:1285962050
Name:STAUFFER, CATHRYN (RD, CNSD)
Entity type:Individual
Prefix:
First Name:CATHRYN
Middle Name:
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:RD, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9160 ESTATE THOMAS
Mailing Address - Street 2:PMB 186
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-3641
Mailing Address - Country:US
Mailing Address - Phone:434-249-1204
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL COMPLEX
Practice Address - Street 2:SUITE 13
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-5735
Practice Address - Country:US
Practice Address - Phone:434-249-1204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA966089133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered