Provider Demographics
NPI:1316670854
Name:STAUDER, CARA TERESA (CPNP)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:TERESA
Last Name:STAUDER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:TERESA
Other - Last Name:BUTCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:477 SOUTHWICK ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085
Mailing Address - Country:US
Mailing Address - Phone:413-562-5256
Mailing Address - Fax:413-568-4757
Practice Address - Street 1:477 SOUTHWICK ROAD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085
Practice Address - Country:US
Practice Address - Phone:413-562-5256
Practice Address - Fax:413-568-4757
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT193628163W00000X
MARN2317247163W00000X, 363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics