Provider Demographics
NPI:1114599156
Name:KISZELLA, ALYSSA
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:
Last Name:KISZELLA
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 1:5626 CLEGG DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-2023
Mailing Address - Country:US
Mailing Address - Phone:419-270-2815
Mailing Address - Fax:
Practice Address - Street 1:5626 CLEGG DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-2023
Practice Address - Country:US
Practice Address - Phone:419-270-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty