Healthcare Provider Details

I. General information

NPI: 1821739459
Provider Name (Legal Business Name): CERA CISSNA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 E VIRGINIA ST
EVANSVILLE IN
47715-4068
US

IV. Provider business mailing address

7220 E VIRGINIA ST
EVANSVILLE IN
47715-4068
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-3030
  • Fax:
Mailing address:
  • Phone: 812-485-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02008338A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: