Individual
MARICELDA P PISANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
700 BROADWAY, LAKE ARTHUR, NM 88253
(575) 365-2000
(575) 365-2002
Mailing address
P.O. BOX 55, 301 MAINE, LAKE ARTHUR, NM 88253
(575) 365-2000
(575) 365-2002
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
R33559
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R33559
RN LICENSE
NM
Enumeration date
06/03/2016
Last updated
06/03/2016
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