Provider Demographics
NPI:1407294135
Name:SISSON, ERIN MARIE (RN, RD, LD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:SISSON
Suffix:
Gender:F
Credentials:RN, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10496 MONTGOMERY RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5223
Mailing Address - Country:US
Mailing Address - Phone:513-865-1126
Mailing Address - Fax:513-865-4154
Practice Address - Street 1:10496 MONTGOMERY RD
Practice Address - Street 2:SUITE 206
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5223
Practice Address - Country:US
Practice Address - Phone:513-865-1126
Practice Address - Fax:513-865-4154
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.7154133V00000X
OHRN.334133163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163W00000XNursing Service ProvidersRegistered Nurse