Healthcare Provider Details

I. General information

NPI: 1700677465
Provider Name (Legal Business Name): LORENA CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 SYLVAN ST
GRAND ISLAND NE
68801-7165
US

IV. Provider business mailing address

306 C ST APT 17E
SHELTON NE
68876-9624
US

V. Phone/Fax

Practice location:
  • Phone: 308-216-0894
  • Fax:
Mailing address:
  • Phone: 308-216-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: