Provider Demographics
NPI:1639382773
Name:SAMPSON-SIRIANI, CATHY (MSN,RN,FNP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:SAMPSON-SIRIANI
Suffix:
Gender:F
Credentials:MSN,RN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 CANYON TERRACE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407
Mailing Address - Country:US
Mailing Address - Phone:909-357-5000
Mailing Address - Fax:
Practice Address - Street 1:3704 CANYON TERRACE DR
Practice Address - Street 2:9680 CITRUS AVE, BLGD#33 FONTANA, CA 92335
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-4106
Practice Address - Country:US
Practice Address - Phone:909-883-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily