Individual
JAIME SISAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-AC
Contact information
Practice address
262 DANNY THOMAS PL, MEMPHIS, TN 38105-3678
(530) 305-0709
Mailing address
262 DANNY THOMAS PL, MEMPHIS, TN 38105-3678
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
28380
TN
Other
Enumeration date
12/14/2020
Last updated
12/14/2020
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