Provider Demographics
NPI:1316587876
Name:CISNEROS, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1393
Mailing Address - Country:US
Mailing Address - Phone:206-323-0930
Mailing Address - Fax:206-432-3591
Practice Address - Street 1:1300 SPRING ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1393
Practice Address - Country:US
Practice Address - Phone:206-323-0930
Practice Address - Fax:206-432-3591
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACM60715254374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician