Healthcare Provider Details

I. General information

NPI: 1124661467
Provider Name (Legal Business Name): ASHLEY MARIE SISSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E 70TH ST
NEW YORK NY
10021-4872
US

IV. Provider business mailing address

3900 CITY AVE APT A817
PHILADELPHIA PA
19131-7700
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number780573
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: