Provider Demographics
NPI:1922449065
Name:AYISSI, DESIRE L
Entity Type:Individual
Prefix:
First Name:DESIRE
Middle Name:L
Last Name:AYISSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 LEES CROSSING DR APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-7684
Mailing Address - Country:US
Mailing Address - Phone:513-328-5933
Mailing Address - Fax:
Practice Address - Street 1:5319 LEES CROSSING DR APT 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-7684
Practice Address - Country:US
Practice Address - Phone:513-328-5933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61531156363L00000X
OH386099163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse