Basic Information
| Provider Information | |||||||||
| NPI: | 1639265119 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SISCO | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S. R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 778 RATTLING ROAD | ||||||||
| Address2: | |||||||||
| City: | MICKLETON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562419624 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 KIRKWOOD HIGHWAY | ||||||||
| Address2: | WILMINGTON VA MEDICAL CENTER | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029942511 | ||||||||
| FaxNumber: | 3026335443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 386353 | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.