Provider Demographics
NPI:1619254554
Name:CISSELL, HELENE
Entity Type:Individual
Prefix:
First Name:HELENE
Middle Name:
Last Name:CISSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NORTH LARRABEE STREET
Mailing Address - Street 2:UNIT 801
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-0101
Mailing Address - Country:US
Mailing Address - Phone:513-377-4052
Mailing Address - Fax:
Practice Address - Street 1:700 NORTH LARRABEE STREET
Practice Address - Street 2:UNIT 801
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-0101
Practice Address - Country:US
Practice Address - Phone:513-377-4052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X, 372600000X
OHRN.256530163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion