Doctor Name: | MISS JESSICA N STALEY |
NPI Number: | 1043510050 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 003178 |
Business Practice Address: | 36100 Euclid Ave Suite 320 Willoughby, OH - 440944456 |
Business Phone Number: | 4409511073 |
Business Fax Number: | 4409511844 |
Mailing Address: | 36100 Euclid Ave, Suite 320 WILLOUGHBY |
State: | OH |
Postal Code: | 440944456 |
Phone Number: | 4409511073 |
Fax Number: | 4409511844 |
NPI Enumeration Date: | 10/25/2010 |
NPI Last Update Date: | 10/25/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 003178 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |