Provider Demographics
NPI:1518164128
Name:SISAY, MARIAMA DOMANIE (RN)
Entity Type:Individual
Prefix:
First Name:MARIAMA
Middle Name:DOMANIE
Last Name:SISAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PAGE ST
Mailing Address - Street 2:C
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6727
Mailing Address - Country:US
Mailing Address - Phone:614-604-3631
Mailing Address - Fax:
Practice Address - Street 1:60 PAGE ST
Practice Address - Street 2:C
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6727
Practice Address - Country:US
Practice Address - Phone:614-604-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-298480163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health