Basic Information
| Provider Information | |||||||||
| NPI: | 1750782736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIOLO | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 BERTHA HOWE AVE. | ||||||||
| Address2: | STE.1 | ||||||||
| City: | MESQUITE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890277567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023460800 | ||||||||
| FaxNumber: | 7023460801 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 BERTHA HOWE AVE | ||||||||
| Address2: | STE.1 | ||||||||
| City: | MESQUITE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890277502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023460800 | ||||||||
| FaxNumber: | 7023460801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2014 | ||||||||
| LastUpdateDate: | 09/30/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN001785 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.