Provider Demographics
NPI:1134668361
Name:WHITEHEAD, CERISSA (CNA)
Entity Type:Individual
Prefix:
First Name:CERISSA
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 CLARION AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45207-1206
Mailing Address - Country:US
Mailing Address - Phone:513-254-4873
Mailing Address - Fax:
Practice Address - Street 1:1922 CLARION AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207-1206
Practice Address - Country:US
Practice Address - Phone:513-254-4873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH379089370700376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide