Healthcare Provider Details

I. General information

NPI: 1114133576
Provider Name (Legal Business Name): NANCY E. SISKOWIC NP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 SILVER SPUR RD SUITE 270
ROLLING HILLS ESTATES CA
90274-3602
US

IV. Provider business mailing address

720 VIA SOMONTE
PALOS VERDES ESTATES CA
90274-1629
US

V. Phone/Fax

Practice location:
  • Phone: 310-872-4640
  • Fax: 310-375-8415
Mailing address:
  • Phone: 310-375-8414
  • Fax: 310-375-8415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN139580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: