Healthcare Provider Details

I. General information

NPI: 1447173497
Provider Name (Legal Business Name): MR. CAMERON JAMES SIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34430 ROAD 757
ELSIE NE
69134-4046
US

IV. Provider business mailing address

310 PERKINS AVE
ELSIE NE
69134-2030
US

V. Phone/Fax

Practice location:
  • Phone: 308-289-1113
  • Fax:
Mailing address:
  • Phone: 308-289-6419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number75005945
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: