Provider Demographics
NPI:1114699865
Name:STAPLES, MARISSA
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:STAPLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 ROSCOES FARM LN
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26141-6701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:181 ROSCOES FARM LN
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:WV
Practice Address - Zip Code:26141-6701
Practice Address - Country:US
Practice Address - Phone:304-531-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant