Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 7438 | AZ |
Y | 2251H1200X | Hand | PT60839924 | WA |
N | 2251X0800X | Physical Therapist - Orthopedic | 7438 | AZ |
NPI | 1467534412 |
---|---|
Provider Name | Stephanie W Cisneros |
First Address | Gresham, OR 97030-3376 |
Second Address | Vancouver, WA 98664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 17/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5550830001 | MEDICARE NSC SCW (01) | AZ |
5550830003 | MEDICARE NSC PEORIA (01) | AZ |
5550830004 | MEDICARE NSC PV (01) | AZ |
5550830006 | MEDICARE NSC ANTHEM (01) | AZ |
5550830007 | MEDICARE NSC DV (01) | AZ |
5550830008 | MEDICARE NSC SWV (01) | AZ |
5550830009 | MEDICARE NSC AZ NORTH (01) | AZ |
5550830010 | MEDICARE NSC GILBERT (01) | AZ |