Provider Demographics
NPI:1942933445
Name:SISAY, MERON GIZAW (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MERON
Middle Name:GIZAW
Last Name:SISAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 TENNYSON DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6430
Mailing Address - Country:US
Mailing Address - Phone:513-807-4501
Mailing Address - Fax:
Practice Address - Street 1:6111 TENNYSON DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6430
Practice Address - Country:US
Practice Address - Phone:513-807-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-03
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0031359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily