Provider Demographics
NPI:1487014825
Name:SISK, BERNADETTE NOEL (MSN, RN, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:NOEL
Last Name:SISK
Suffix:
Gender:F
Credentials:MSN, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15655 STATE ROUTE 170 STE A
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9672
Mailing Address - Country:US
Mailing Address - Phone:330-386-4303
Mailing Address - Fax:
Practice Address - Street 1:15655 STATE ROUTE 170 STE A
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9672
Practice Address - Country:US
Practice Address - Phone:330-386-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-27
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN366572163WP0808X
OHAPRN.CNP.019564363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health