Provider Demographics
NPI:1518291350
Name:SIAO, EDNA LOMIBAO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:EDNA
Middle Name:LOMIBAO
Last Name:SIAO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:EDNA
Other - Middle Name:DE OCAMPO
Other - Last Name:LOMIBAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 FARMGATE CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4602
Mailing Address - Country:US
Mailing Address - Phone:916-316-7219
Mailing Address - Fax:
Practice Address - Street 1:4501 X ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2229
Practice Address - Country:US
Practice Address - Phone:916-734-5959
Practice Address - Fax:916-457-4542
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-27
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19368363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner