Provider Demographics
NPI:1366891004
Name:PISANA, MARICELDA P (RN, BSN)
Entity type:Individual
Prefix:
First Name:MARICELDA
Middle Name:P
Last Name:PISANA
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 55
Mailing Address - Street 2:301 MAINE
Mailing Address - City:LAKE ARTHUR
Mailing Address - State:NM
Mailing Address - Zip Code:88253
Mailing Address - Country:US
Mailing Address - Phone:575-365-2000
Mailing Address - Fax:575-365-2002
Practice Address - Street 1:700 BROADWAY
Practice Address - Street 2:
Practice Address - City:LAKE ARTHUR
Practice Address - State:NM
Practice Address - Zip Code:88253
Practice Address - Country:US
Practice Address - Phone:575-365-2000
Practice Address - Fax:575-365-2002
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR33559163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR33559OtherRN LICENSE