Provider Demographics
NPI:1265955157
Name:CISNEROS SIGGINS, KEELEY (NP-C)
Entity type:Individual
Prefix:MRS
First Name:KEELEY
Middle Name:
Last Name:CISNEROS SIGGINS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KEELEY
Other - Middle Name:A
Other - Last Name:CISNEROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4337 W INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-2982
Mailing Address - Country:US
Mailing Address - Phone:602-576-3903
Mailing Address - Fax:
Practice Address - Street 1:4337 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-2982
Practice Address - Country:US
Practice Address - Phone:602-576-3903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10195363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily