Provider Demographics
NPI:1962647016
Name:OLDANI, CISCO JOHN
Entity Type:Individual
Prefix:MR
First Name:CISCO
Middle Name:JOHN
Last Name:OLDANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 COYOTE LOOP
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:WY
Mailing Address - Zip Code:83014-9668
Mailing Address - Country:US
Mailing Address - Phone:307-690-9817
Mailing Address - Fax:
Practice Address - Street 1:2245 COYOTE LOOP
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-9668
Practice Address - Country:US
Practice Address - Phone:307-690-9817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care