=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427338201
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH I. DISSER RN, NP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2011
-----------------------------------------------------
Last Update Date | 11/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20265 EMERY RD
-----------------------------------------------------
City | NORTH RANDALL
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44128-4122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-523-9966
-----------------------------------------------------
Fax | 216-584-2895
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9789 WOODMILL LN
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45231-3725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-240-2079
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN.352837-
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | COA.12749-NP
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.12749
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------