Healthcare Provider Details

I. General information

NPI: 1679932644
Provider Name (Legal Business Name): JENNIFER L CISLER HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4664 E WASHINGTON AVE
MADISON WI
53704-3236
US

IV. Provider business mailing address

4664 E WASHINGTON AVE
MADISON WI
53704-3236
US

V. Phone/Fax

Practice location:
  • Phone: 608-243-8084
  • Fax:
Mailing address:
  • Phone: 608-243-8084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1455-60
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: