Provider Demographics
NPI:1972172104
Name:BRESEE, SANDRA FAYE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:FAYE
Last Name:BRESEE
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 1:6208 PENEPLAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-5466
Mailing Address - Country:US
Mailing Address - Phone:980-439-3760
Mailing Address - Fax:
Practice Address - Street 1:6208 PENEPLAIN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-5466
Practice Address - Country:US
Practice Address - Phone:980-439-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant