Provider Demographics
NPI:1194421040
Name:SISON, EDNA PASCUAL
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:PASCUAL
Last Name:SISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 SKYLAR LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-6942
Mailing Address - Country:US
Mailing Address - Phone:559-821-9905
Mailing Address - Fax:
Practice Address - Street 1:1069 SKYLAR LN
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-6942
Practice Address - Country:US
Practice Address - Phone:559-821-9905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA829933163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse