Provider Demographics
NPI:1558192765
Name:CISNEROS, LUCY P (RN, CCM)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:P
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 E PEBBLE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3237
Mailing Address - Country:US
Mailing Address - Phone:702-614-1149
Mailing Address - Fax:877-211-6856
Practice Address - Street 1:4630 S LAKESHORE DR APT 176
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7174
Practice Address - Country:US
Practice Address - Phone:480-522-7954
Practice Address - Fax:877-211-6856
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN127821163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management