Provider Demographics
NPI:1992257414
Name:STAUFFER, JOAN ELIZABETH WOLFE (CTRS, ATRIC)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:ELIZABETH WOLFE
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:CTRS, ATRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9604 PALMER
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189
Mailing Address - Country:US
Mailing Address - Phone:734-883-8932
Mailing Address - Fax:810-462-1139
Practice Address - Street 1:9604 PALMER
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189
Practice Address - Country:US
Practice Address - Phone:734-883-8932
Practice Address - Fax:810-462-1139
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI60571171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor