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NPI Code Detail

MEDICARE: MISTEL STASSIN PMHNP-BC, CARN-AP

MEDICARE: MISTEL STASSIN PMHNP-BC, CARN-AP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner025439OH
2163W00000XRegistered NurseRN.413214OH

General Provider Information

NPI Number : 1255810933
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTEL STASSIN PMHNP-BC, CARN-AP
Provider Business Mailing Address
First Line : 1460 TOD AVE NW
Second Line :
City : WARREN
State : OH
Zip : 44485-2407
Country : US
Telephone Number : 330-392-0311
Fax Number :
Provider Business Practice Location Address
First Line : 1460 TOD AVE NW
Second Line :
City : WARREN
State : OH
Zip : 44485-2407
Country : US
Telephone Number : 330-392-0311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2018
Last Update Date : 05/14/2024

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