Healthcare Provider Details

I. General information

NPI: 1104414598
Provider Name (Legal Business Name): NANCY CISNEROS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2021
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 CHERRY TREE LN
RIVERBANK CA
95367-2105
US

IV. Provider business mailing address

2230 CHERRY TREE LN
RIVERBANK CA
95367-2105
US

V. Phone/Fax

Practice location:
  • Phone: 209-380-4242
  • Fax:
Mailing address:
  • Phone: 209-380-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: