Healthcare Provider Details

I. General information

NPI: 1285338723
Provider Name (Legal Business Name): MELISSA GISSENTANER-HALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD # 1-E344
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

4388 ACACIA DR
SOUTH EUCLID OH
44121-3306
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax: 216-229-6149
Mailing address:
  • Phone: 216-299-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN325369
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: