Individual
BRODERICK STAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
410 S RAMPART BLVD STE 390, LAS VEGAS, NV 89145-5749
(702) 751-0356
Mailing address
410 S RAMPART BLVD STE 390, LAS VEGAS, NV 89145-5749
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
06/30/2022
Last updated
06/30/2022
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