Provider Demographics
NPI:1518002351
Name:SISNEROS, ALICE (RN)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:SISNEROS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CENTRAL MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-4212
Mailing Address - Country:US
Mailing Address - Phone:719-583-4380
Mailing Address - Fax:719-583-4375
Practice Address - Street 1:151 CENTRAL MAIN ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-4212
Practice Address - Country:US
Practice Address - Phone:719-583-4380
Practice Address - Fax:719-583-4375
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO119995163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32401396Medicaid