Healthcare Provider Details

I. General information

NPI: 1376705632
Provider Name (Legal Business Name): LINDSEY A SISCO RN, APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY A MCEVERS RN, APNP

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36500 AURORA DR
SUMMIT WI
53066-4899
US

IV. Provider business mailing address

36500 AURORA DR
SUMMIT WI
53066-4899
US

V. Phone/Fax

Practice location:
  • Phone: 262-434-8800
  • Fax:
Mailing address:
  • Phone: 262-434-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number147843
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3506-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3506-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: