Healthcare Provider Details

I. General information

NPI: 1518686351
Provider Name (Legal Business Name): MELISSA STEPHANIE SISKO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 W 44TH AVE UNIT 200
WHEAT RIDGE CO
80033-2742
US

IV. Provider business mailing address

2659 QUAIL ST
LAKEWOOD CO
80215-7174
US

V. Phone/Fax

Practice location:
  • Phone: 303-993-1330
  • Fax:
Mailing address:
  • Phone: 720-209-5213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0997867-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: