Healthcare Provider Details

I. General information

NPI: 1679236772
Provider Name (Legal Business Name): ERIN CISEWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2021
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9817 N 95TH ST STE 107
SCOTTSDALE AZ
85258-4587
US

IV. Provider business mailing address

32629 N CHERRY CREEK RD
QUEEN CREEK AZ
85142-6745
US

V. Phone/Fax

Practice location:
  • Phone: 602-765-2229
  • Fax:
Mailing address:
  • Phone: 303-667-0983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: