Provider Demographics
NPI:1427338201
Name:DISSER, JOSEPH I (RN, NP-C)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:I
Last Name:DISSER
Suffix:
Gender:M
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9789 WOODMILL LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-3725
Mailing Address - Country:US
Mailing Address - Phone:513-240-2079
Mailing Address - Fax:
Practice Address - Street 1:20265 EMERY RD
Practice Address - Street 2:
Practice Address - City:NORTH RANDALL
Practice Address - State:OH
Practice Address - Zip Code:44128-4122
Practice Address - Country:US
Practice Address - Phone:440-523-9966
Practice Address - Fax:216-584-2895
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.352837-163W00000X
OHCOA.12749-NP363LA2200X
OHAPRN.CNP.12749363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0076250Medicaid