MEDICARE: JANICE CISE PHD, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SA2200X	Adult Health Clinical Nurse Specialist	28055255A	IN
2	364SH1100X	Holistic Clinical Nurse Specialist	28055255A	IN

General Provider Information

NPI Number	:	1427505528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE CISE PHD, RN

Provider Business Mailing Address
First Line	:	1350 W SOUTHPORT RD # 110
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-9127
Country	:	US
Telephone Number	:	317-201-6903
Fax Number	:

Provider Business Practice Location Address
First Line	:	5524 S EMERSON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-2517
Country	:	US
Telephone Number	:	317-201-6903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/07/2016

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