Individual
DR. CHARISSE NISCE SIAPNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
205 FERN VALLEY RD STE A, PHOENIX, OR 97535-9100
(541) 535-1274
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(541) 535-1274
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
099202
OH
207R00000X
Internal Medicine Physician
Primary
MD171548
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500689112
—
OR
Enumeration date
07/28/2009
Last updated
11/05/2015
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