Provider Demographics
NPI:1891126538
Name:BISENIUS, SYDMARIE (ND)
Entity Type:Individual
Prefix:DR
First Name:SYDMARIE
Middle Name:
Last Name:BISENIUS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24850 SE STARK ST STE 150
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8318
Mailing Address - Country:US
Mailing Address - Phone:503-491-0714
Mailing Address - Fax:
Practice Address - Street 1:24850 SE STARK ST STE 150
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8318
Practice Address - Country:US
Practice Address - Phone:503-491-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORND2029208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics