Provider Demographics
NPI:1457627820
Name:STAPLES, BRENDA DENISE
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:DENISE
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 1:3540 W SAHARA AVE
Mailing Address - Street 2:8
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-5816
Mailing Address - Country:US
Mailing Address - Phone:702-336-0263
Mailing Address - Fax:
Practice Address - Street 1:3540 W SAHARA AVE
Practice Address - Street 2:8
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-5816
Practice Address - Country:US
Practice Address - Phone:702-336-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner