Provider Demographics
NPI:1043578933
Name:SISSON, TINA (STNA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:SISSON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9508 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:N BLOOMFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44450
Mailing Address - Country:US
Mailing Address - Phone:330-583-0043
Mailing Address - Fax:
Practice Address - Street 1:9508 PARK AVE
Practice Address - Street 2:
Practice Address - City:N BLOOMFIELD
Practice Address - State:OH
Practice Address - Zip Code:44450-9754
Practice Address - Country:US
Practice Address - Phone:330-583-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant