Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1030132 | TX |
NPI | 1003409723 |
---|---|
Provider Name | Mrs. Jessica D Ann Sisneros |
First Address | Lubbock, TX 79410-1203 |
Second Address | Levelland, TX 79336-4424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2021 |
Last Update Date | 13/04/2021 |