Provider Demographics
NPI:1275960882
Name:SISON, MICHAEL JOHN SALVANA (RN, NP, RNFA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL JOHN
Middle Name:SALVANA
Last Name:SISON
Suffix:
Gender:M
Credentials:RN, NP, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11910 IRWINDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-6496
Mailing Address - Country:US
Mailing Address - Phone:661-444-0889
Mailing Address - Fax:
Practice Address - Street 1:11910 IRWINDALE AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-6496
Practice Address - Country:US
Practice Address - Phone:661-444-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN740119163W00000X, 163WR0006X
CA95032547363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant