Provider Demographics
NPI:1720880164
Name:STAAB, SHANA MICHELE (RN)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:MICHELE
Last Name:STAAB
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 1:1509 RIDGE TOP DR NE
Mailing Address - Street 2:
Mailing Address - City:SWISHER
Mailing Address - State:IA
Mailing Address - Zip Code:52338-9421
Mailing Address - Country:US
Mailing Address - Phone:319-533-7135
Mailing Address - Fax:
Practice Address - Street 1:1075 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5003
Practice Address - Country:US
Practice Address - Phone:319-558-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089438163WP2201X, 163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care