MEDICARE: GINA MARIE HISSONG CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	NP08086	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	NP17352	OTHER	OH	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548263239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MARIE HISSONG CNP

Provider Business Mailing Address
First Line	:	4460 RED BANK EXPRESSWAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-2173
Country	:	US
Telephone Number	:	513-791-5200
Fax Number	:	513-791-5229

Provider Business Practice Location Address
First Line	:	4460 RED BANK EXPRESSWAY
Second Line	:	SUITE 110
City	:	CINCINNATI
State	:	OH
Zip	:	45227-2173
Country	:	US
Telephone Number	:	513-791-5200
Fax Number	:	513-791-5229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/11/2017

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Directions to “ GINA MARIE HISSONG CNP” Practice Location

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