Provider Demographics
NPI:1003413279
Name:SISLEY, ERMA MARIE
Entity Type:Individual
Prefix:MS
First Name:ERMA
Middle Name:MARIE
Last Name:SISLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44003-0232
Mailing Address - Country:US
Mailing Address - Phone:440-293-7528
Mailing Address - Fax:
Practice Address - Street 1:281 GATES ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003-7101
Practice Address - Country:US
Practice Address - Phone:440-293-7528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker