Provider Demographics
NPI:1083460935
Name:PISIW, PAULINE (RN)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:PISIW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8552 COTTONSEED WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4592
Mailing Address - Country:US
Mailing Address - Phone:916-833-5481
Mailing Address - Fax:
Practice Address - Street 1:8552 COTTONSEED WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4592
Practice Address - Country:US
Practice Address - Phone:916-833-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA713830163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse