Individual
MR. CARL WILLIAM SISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-7070
(731) 541-7075
Mailing address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-7070
(731) 541-7075
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
134913
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3630440
—
TN
Enumeration date
01/23/2006
Last updated
12/07/2010
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