Healthcare Provider Details

I. General information

NPI: 1023275914
Provider Name (Legal Business Name): DANIELLE KIGGINS SISUL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE KIGGINS SISUL M.D

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SUNSET DR
LA GRANDE OR
97850-1387
US

IV. Provider business mailing address

900 SUNSET DR
LA GRANDE OR
97850-1387
US

V. Phone/Fax

Practice location:
  • Phone: 541-963-8421
  • Fax:
Mailing address:
  • Phone: 541-963-8421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA110532
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM-13396
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0054868
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: