Provider Demographics
NPI:1255810933
Name:STASSIN, MISTEL (PMHNP-BC, CARN-AP)
Entity type:Individual
Prefix:
First Name:MISTEL
Middle Name:
Last Name:STASSIN
Suffix:
Gender:F
Credentials:PMHNP-BC, CARN-AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 TOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2407
Mailing Address - Country:US
Mailing Address - Phone:330-392-0311
Mailing Address - Fax:
Practice Address - Street 1:1460 TOD AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2407
Practice Address - Country:US
Practice Address - Phone:330-392-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH025439363LP0808X
OHRN.413214163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse