Provider Demographics
NPI:1659075349
Name:BISSELL, DENISE ANN (RN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:BISSELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:ANN
Other - Last Name:MAKSYMIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1600 CLINTON STREET RD
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-9718
Mailing Address - Country:US
Mailing Address - Phone:585-591-0824
Mailing Address - Fax:
Practice Address - Street 1:1600 CLINTON STREET RD
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-9718
Practice Address - Country:US
Practice Address - Phone:585-591-0824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY435403-1163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice