Healthcare Provider Details

I. General information

NPI: 1245296326
Provider Name (Legal Business Name): KRYN L SISCO PMHNP-BC, MPA,BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD STE 216
LANSING MI
48910-6818
US

IV. Provider business mailing address

101 W TOWNSEND RD
SAINT JOHNS MI
48879-9200
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-9554
  • Fax: 517-346-8291
Mailing address:
  • Phone: 989-403-6100
  • Fax: 989-403-6120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704152662
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: