Provider Demographics
NPI:1609965755
Name:SISNROY, LOUISA JEANETTE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:LOUISA
Middle Name:JEANETTE
Last Name:SISNROY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-2138
Mailing Address - Country:US
Mailing Address - Phone:719-384-5446
Mailing Address - Fax:719-363-1115
Practice Address - Street 1:711 BARNES AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2138
Practice Address - Country:US
Practice Address - Phone:719-384-5446
Practice Address - Fax:719-363-1115
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0004974-NP363LF0000X
CO4974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76820874Medicaid
COCO301902Medicare PIN