Provider Demographics
NPI:1922145614
Name:HISIRO, EDNA PAULINE (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:EDNA
Middle Name:PAULINE
Last Name:HISIRO
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:CABIN CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25035-0280
Mailing Address - Country:US
Mailing Address - Phone:304-344-1623
Mailing Address - Fax:337-943-0846
Practice Address - Street 1:640 SANDHILL RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2163
Practice Address - Country:US
Practice Address - Phone:304-675-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013917363LF0000X
WVAPRN54832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3380640OtherMEDICARE GROUP NUMBER
TNAPN11548OtherAPN LICENSE NUMBER
TNRN151420OtherRN LICENSE NUMBER
TN3380640OtherMEDICAID GROUP
TN3380640OtherMEDICAID GROUP
TN3641827Medicare PIN