BRENT SISSOM (NPI# 1730331240) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730331240 |
| Entity Type | Individual |
| Full Name | BRENT SISSOM |
| Credential | CRT |
| Practice Address |
1519 3rd St Se Suite 103 Puyallup WA 98372-3742 |
| Mailing Address |
1519 3rd St Se Suite 101 Puyallup WA 98372-3742 |
| Practice Telephone | 2538418939 |
| Mailing Telephone | 2538418939 |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2008-10-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 247100000X | Radiologic Technologist | RT00003985 | WA | Technologists, Technicians & Other Technical Service Providers |
| Street Address |
1519 3RD ST SE SUITE 103 |
| City | PUYALLUP |
| State | WA |
| Zip Code | 98372-3742 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831176999 | Helene Susan Dehaan | Nurse Practitioner | 1519 3rd St Se, Suite 101, Puyallup, WA 98372-3742 | 2005-12-29 |
| 1053764522 | Yarrow J. Mcconnell | Surgery | 1519 3rd St Se, Suite 230, Puyallup, WA 98372-3742 | 2016-07-19 |
| 1437443348 | Ryan J Street | Urology | 1519 3rd St Se, Suite 210, Puyallup, WA 98372-3742 | 2011-06-08 |
| 1417257668 | Eugenia Byrne | Nurse Practitioner | 1519 3rd St Se, Suite 101, Puyallup, WA 98372-3742 | 2010-10-21 |
| 1174799282 | South Sound Neurosurgery Pllc | Clinic/Center | 1519 3rd St Se, Suite 103, Puyallup, WA 98372-3742 | 2008-05-08 |
| 1003094889 | Gregory Ryan Lamberton | Urology | 1519 3rd St Se, Ste 210, Puyallup, WA 98372-3724 | 2008-02-04 |
| 1801098405 | Robin Yune Lee | Urology | 1519 3rd St Se, Suite 210, Puyallup, WA 98372-3742 | 2007-06-05 |
| 1104048594 | Partner Oncology Inc | Clinic/Center | 1519 3rd St Se, Suite 260, Puyallup, WA 98372 | 2007-05-03 |
| 1235261884 | Apple Physical Therapy Ps | Durable Medical Equipment & Medical Supplies | 1519 3rd St Se, Suite 104, Puyallup, WA 98372-3742 | 2007-03-09 |
| 1417027681 | Candy Nelson | Physical Therapist | 1519 3rd St Se, Suite 104, Puyallup, WA 98372-3742 | 2006-11-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295371532 | Jeffrey Allen Zhan | Urology | Good Samaritan Medical Office Bldg 1450 5th St Se, Suite 2100- Urology Clinic, Puyallup, WA 98372 | 2019-11-21 |
| 1447811419 | Serenity Counseling & Consulting, LLC | Marriage & Family Therapist | 102 23rd St Se, Unit B, Puyallup, WA 98372 | 2019-06-21 |
| 1316401565 | Katherine Juarez Davidson | Nurse Practitioner | 325 E Pioneer # A145, Puyallup, WA 98372 | 2019-01-22 |
| 1679041404 | Cara Ann Lundin | Nurse Practitioner | 11926 43rd St Crt E, Edgewood, WA 98372 | 2018-11-09 |
| 1104392109 | Megan Black | Occupational Therapist | 40 29th St Ne, Puyallup, WA 98372 | 2018-10-17 |
| 1063919470 | Myriah Shekinah Olakpe | Occupational Therapist | 516 Se 23rd Ave, Puyallup, WA 98372 | 2018-04-11 |
| 1902330202 | Tyler Girdler | Student in an Organized Health Care Education/Training Program | 1322 3rd Street Se Suite 240, Puyallup, WA 98372 | 2017-04-13 |
| 1770039471 | Mahalakshmi Hariharan | Pharmacist | 2117 28th St Se, Puyallup, WA 98372 | 2016-09-01 |
| 1801241112 | Nawazish Ali | Internal Medicine | 401 15th Ave Se Multicare God Samartian Hopsital, Puyallup, WA 98372 | 2016-04-25 |
| 1932567559 | Denice L. Voss | Physical Therapist | 400 29th St. Ne, Puyallup, WA 98372 | 2016-02-10 |
| Find all providers in zip 98372 | ||||
| Taxonomy Code | 247100000X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Radiologic Technologist |
| An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076677 | Alexander Toro Rivas | Radiologic Technologist | 5914 158th Way Ne, Redmond, WA 98052-4812 | 2020-09-04 |
| 1043600836 | Bruce Roderick Nielson | Radiologic Technologist | 415 Ne 194th St, Unit 1, Ridgefield, WA 98642-9496 | 2015-01-30 |
| 1598160285 | Young Nam Yoo | Radiologic Technologist | 28705 34th Ave S, Apt K106, Auburn, WA 98001 | 2014-10-24 |
| 1902213861 | J Daniel Kelleher | Radiologic Technologist | 24 Roy St # 457, Seattle, WA 98109-4018 | 2014-07-11 |
| 1194137786 | Julia Ann Katzenmaier | Radiologic Technologist | 23415 27th Ave S, Des Moines, WA 98198-8743 | 2014-05-30 |
| 1093126567 | Gary Dale Kirschner | Radiologic Technologist | 24230 85th Ave Se, Woodinville, WA 98072-9525 | 2014-05-18 |
| 1417373549 | Jayme Ebner | Radiologic Technologist | 1517 N Lacey St, Spokane, WA 99207-5272 | 2014-03-13 |
| 1184949117 | Thomas Olof Malmevik | Radiologic Technologist | 3106 123rd St Se, Everett, WA 98208-6146 | 2010-04-01 |
| 1801118468 | Lynne Marie Bennett | Radiologic Technologist | 2325 Pleasanton Ct Se, Lacey, WA 98503-3410 | 2010-02-24 |
| 1790013233 | Arthur Alan Stevens | Radiologic Technologist | 12105 38th Ave Ne, Marysville, WA 98271-8412 | 2009-11-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.