Healthcare Provider Details

I. General information

NPI: 1881088920
Provider Name (Legal Business Name): DEBRA SISSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

150 MUIR ROAD
MARTINEZ CA
94553
US

V. Phone/Fax

Practice location:
  • Phone: 916-677-6824
  • Fax: 925-370-4712
Mailing address:
  • Phone: 916-677-6824
  • Fax: 925-370-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number365192
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License Number2005455030
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number2005455030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: