Provider Demographics
NPI:1003385360
Name:NEISSL, CEGE (QBHP)
Entity Type:Individual
Prefix:
First Name:CEGE
Middle Name:
Last Name:NEISSL
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 E WALNUT
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:AR
Mailing Address - Zip Code:72855
Mailing Address - Country:US
Mailing Address - Phone:479-963-2143
Mailing Address - Fax:479-963-2144
Practice Address - Street 1:2007 E WALNUT
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:AR
Practice Address - Zip Code:72855
Practice Address - Country:US
Practice Address - Phone:479-963-2143
Practice Address - Fax:479-963-2144
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator