Provider Demographics
NPI:1053389767
Name:STAPLETON, LAURIE R (DO)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:R
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 COROLLA CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5567
Mailing Address - Country:US
Mailing Address - Phone:702-898-5681
Mailing Address - Fax:702-227-8939
Practice Address - Street 1:51 COROLLA CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-5567
Practice Address - Country:US
Practice Address - Phone:702-898-5681
Practice Address - Fax:702-227-8939
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV731208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG01213Medicare UPIN