Healthcare Provider Details

I. General information

NPI: 1588853832
Provider Name (Legal Business Name): ANN M CISNEROS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 JORIE LN
WALPOLE MA
02081-1923
US

IV. Provider business mailing address

27 JORIE LN
WALPOLE MA
02081-1923
US

V. Phone/Fax

Practice location:
  • Phone: 508-660-9503
  • Fax:
Mailing address:
  • Phone: 508-660-9503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number149879
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: