Healthcare Provider Details

I. General information

NPI: 1548263239
Provider Name (Legal Business Name): GINA MARIE HISSONG CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 RED BANK EXPRESSWAY SUITE 110
CINCINNATI OH
45227-2173
US

IV. Provider business mailing address

4460 RED BANK EXPRESSWAY
CINCINNATI OH
45227-2173
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-5200
  • Fax: 513-791-5229
Mailing address:
  • Phone: 513-791-5200
  • Fax: 513-791-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP08086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: