Healthcare Provider Details

I. General information

NPI: 1346489358
Provider Name (Legal Business Name): TREASA J CISERO RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JEFFERSON AVE
MEMPHIS TN
38104-2127
US

IV. Provider business mailing address

1114 GOODWIN CIR
WEST MEMPHIS AR
72301-2148
US

V. Phone/Fax

Practice location:
  • Phone: 901-544-1060
  • Fax:
Mailing address:
  • Phone: 901-219-1432
  • Fax: 870-394-4787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License Number2615
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number3752
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: