Provider Demographics
NPI:1821282708
Name:KISEL, YELENA (RN, PHN, FNP)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:KISEL
Suffix:
Gender:F
Credentials:RN, PHN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:4010 FOOTHILLS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-7241
Practice Address - Country:US
Practice Address - Phone:916-453-5141
Practice Address - Fax:916-771-2108
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 592801163W00000X
171M00000X
CANP16743363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA592801OtherRN LICENSE
CACA114035Medicare PIN