Provider Demographics
NPI:1619495975
Name:BISBANO, CAROLANN (RN)
Entity Type:Individual
Prefix:
First Name:CAROLANN
Middle Name:
Last Name:BISBANO
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 1:1724 W CLAREMONT ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2028
Mailing Address - Country:US
Mailing Address - Phone:602-803-2625
Mailing Address - Fax:
Practice Address - Street 1:4502 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1817
Practice Address - Country:US
Practice Address - Phone:602-764-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ142445163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool