Provider Demographics
NPI:1861843161
Name:BISA-CISTER, JANE RENELLE (NP)
Entity Type:Individual
Prefix:MISS
First Name:JANE RENELLE
Middle Name:
Last Name:BISA-CISTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2538
Mailing Address - Country:US
Mailing Address - Phone:718-471-3400
Mailing Address - Fax:
Practice Address - Street 1:2241 NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2538
Practice Address - Country:US
Practice Address - Phone:718-471-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307758363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health