Provider Demographics
NPI:1124309497
Name:STATEN, ANTHONY MARKELL
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MARKELL
Last Name:STATEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 DARA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6563
Mailing Address - Country:US
Mailing Address - Phone:702-750-7988
Mailing Address - Fax:
Practice Address - Street 1:6225 DARA ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6563
Practice Address - Country:US
Practice Address - Phone:702-750-7988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner