MEDICARE: HELENE CISSELL

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
1	376J00000X	Homemaker
2	372600000X	Adult Companion
3	163WH0200X	Home Health Registered Nurse	RN.256530	OH

General Provider Information

NPI Number	:	1619254554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELENE CISSELL

Provider Business Mailing Address
First Line	:	700 NORTH LARRABEE STREET
Second Line	:	UNIT 801
City	:	CHICAGO
State	:	IL
Zip	:	60654-0101
Country	:	US
Telephone Number	:	513-377-4052
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 NORTH LARRABEE STREET
Second Line	:	UNIT 801
City	:	CHICAGO
State	:	IL
Zip	:	60654-0101
Country	:	US
Telephone Number	:	513-377-4052
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2011
Last Update Date	:	06/16/2018

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