Active NPI
Sara Sisco
- Nurse Practitioner
- Gladwin, MI
National Provider Identifier
1386068872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 4704213071
- Practice address
- 609 Quarter St
Gladwin, MI 48624-1941 - Phone
- (989) 246-6490
- NPI assigned
- Feb 5, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4704213071 | MI | Primary |
Addresses
Primary practice location
609 Quarter St
Gladwin, MI 48624-1941
Mailing address
609 Quarter St
Gladwin, MI 48624-1941
Phone (989) 246-6371
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- ssisco37754@mymichiganhealth.midirect.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392940800000",
"number": "1386068872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "609 QUARTER ST",
"city": "GLADWIN",
"state": "MI",
"postal_code": "486241941",
"telephone_number": "989-246-6371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "609 QUARTER ST",
"city": "GLADWIN",
"state": "MI",
"postal_code": "486241941",
"telephone_number": "989-246-6490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SISCO",
"first_name": "SARA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-05",
"last_updated": "2014-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704213071",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gladwin, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.