Healthcare Provider Details

I. General information

NPI: 1316744386
Provider Name (Legal Business Name): NICOLE V CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANOR RD
SIDNEY NE
69162-1142
US

IV. Provider business mailing address

925 10TH AVE
SIDNEY NE
69162-1609
US

V. Phone/Fax

Practice location:
  • Phone: 720-569-8135
  • Fax:
Mailing address:
  • Phone: 308-249-6728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: