MEDICARE: DEEANNE MICHELLE SISCO-BRIDGES 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	163W00000X	Registered Nurse	820188	TX

General Provider Information

NPI Number	:	1831862465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEANNE MICHELLE SISCO-BRIDGES RN

Provider Business Mailing Address
First Line	:	5301 MESQUITE SPRINGS TRL
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79119-6989
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 MESQUITE SPRINGS TRL
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79119-6989
Country	:	US
Telephone Number	:	806-677-6274
Fax Number	:

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

Provider Enumeration Date	:	07/29/2021
Last Update Date	:	07/29/2021

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