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General NPI Number Information
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NPI Number | 1447885405
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Entity Type | Individual
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Provider Name | DEBORRAH CAROLINE CISNEROS HEALTH&WELLNESSCOACH
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Gender | Female
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Dates
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Enumeration Date | 03/10/2020
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 17298 WOMBLE MILL RD
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City | ZUNI
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State | VA
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Zip | 23898-3543
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Country | US
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Telephone | 912-441-6288
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Fax |
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Provider Business Mailing Address
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Address Line | 514 AMERICAS WAY PMB18056
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City | BOX ELDER
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State | SD
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Zip | 57719
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | RN165950
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | 270559322
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License Number State | CA
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