Provider Demographics
NPI:1982665535
Name:STAPLES, LINDA M (RD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:STAPLES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2837
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 FAIRHURST ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4564
Practice Address - Country:US
Practice Address - Phone:970-522-0122
Practice Address - Fax:970-522-8532
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO650174133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P50342Medicare UPIN
COC457228Medicare PIN
COC457238Medicare PIN
COCOA102906Medicare PIN
COCOA102905Medicare PIN