Provider Demographics
NPI:1699219188
Name:HISSNER, ANGELA M (CNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:HISSNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:DATKULIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6724 WALES AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9006
Mailing Address - Country:US
Mailing Address - Phone:330-837-4264
Mailing Address - Fax:330-837-9195
Practice Address - Street 1:6724 WALES AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9006
Practice Address - Country:US
Practice Address - Phone:330-837-4264
Practice Address - Fax:330-837-9195
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily