Healthcare Provider Details

I. General information

NPI: 1427338201
Provider Name (Legal Business Name): JOSEPH I. DISSER RN, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20265 EMERY RD
NORTH RANDALL OH
44128-4122
US

IV. Provider business mailing address

9789 WOODMILL LN
CINCINNATI OH
45231-3725
US

V. Phone/Fax

Practice location:
  • Phone: 440-523-9966
  • Fax: 216-584-2895
Mailing address:
  • Phone: 513-240-2079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.352837-
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.12749-NP
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.12749
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: