Provider Demographics
NPI:1366550634
Name:STUTZMAN, JEANNE MARIE (MEDICAID WAIVER RESI)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:MARIE
Last Name:STUTZMAN
Suffix:
Gender:F
Credentials:MEDICAID WAIVER RESI
Other - Prefix:MR
Other - First Name:CURTIS
Other - Middle Name:JON
Other - Last Name:STUTZMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MEDICAID WAIVER RES
Mailing Address - Street 1:223 E SPRINGBOOK RD
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815
Mailing Address - Country:US
Mailing Address - Phone:540-896-3344
Mailing Address - Fax:
Practice Address - Street 1:223 E SPRINGBOOK RD
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815
Practice Address - Country:US
Practice Address - Phone:540-896-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist