1730295148 NPI number — EVELYN RENEE STAUDE MSN, RN, CRNP

Table of content: EVELYN RENEE STAUDE MSN, RN, CRNP (NPI 1730295148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730295148 NPI number — EVELYN RENEE STAUDE MSN, RN, CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAUDE
Provider First Name:
EVELYN
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STAUDE
Provider Other First Name:
RENEE
Provider Other Middle Name:
HALL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN,RN,CRNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1730295148
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2345
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNISTON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36202-2345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-231-7500
Provider Business Mailing Address Fax Number:
256-231-7501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 HIGHWAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36203-1951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-231-7500
Provider Business Practice Location Address Fax Number:
256-231-7501
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1044391 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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