Provider Demographics
NPI:1831307370
Name:SISON, JENNY ASUNCION (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:ASUNCION
Last Name:SISON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 CAMERON LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-7584
Mailing Address - Country:US
Mailing Address - Phone:765-447-7454
Mailing Address - Fax:
Practice Address - Street 1:3401 SOLDIERS HOME RD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE BRA
Practice Address - State:IN
Practice Address - Zip Code:47906-1222
Practice Address - Country:US
Practice Address - Phone:765-463-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007912A313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility