Provider Demographics
NPI:1306336326
Name:SISON MARIANO, JENNIFER ANNE (RN, CWOCN, WCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:SISON MARIANO
Suffix:
Gender:F
Credentials:RN, CWOCN, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26542 BROOKS CIR
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1432
Mailing Address - Country:US
Mailing Address - Phone:661-312-4956
Mailing Address - Fax:
Practice Address - Street 1:26542 BROOKS CIR
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-1432
Practice Address - Country:US
Practice Address - Phone:661-312-4956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA607624163W00000X, 163WC2100X, 163WE0900X, 163WH0200X, 163WP2201X, 163WX1500X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care