Provider Demographics
NPI:1366841736
Name:HISSNER, RITA (LPN)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:HISSNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 STATE ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-1527
Mailing Address - Country:US
Mailing Address - Phone:330-877-6811
Mailing Address - Fax:330-484-3431
Practice Address - Street 1:3915 STATE ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-1527
Practice Address - Country:US
Practice Address - Phone:330-877-6811
Practice Address - Fax:330-484-3431
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 048981-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse