Basic Information
| Provider Information | |||||||||
| NPI: | 1407294135 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SISSON | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | R.N., R.D., L.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10496 MONTGOMERY RD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452425223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138651126 | ||||||||
| FaxNumber: | 5138654154 | ||||||||
| Practice Location | |||||||||
| Address1: | 10496 MONTGOMERY RD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452425223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138651126 | ||||||||
| FaxNumber: | 5138654154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2013 | ||||||||
| LastUpdateDate: | 06/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | LD.7154 | OH | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 163W00000X | RN.334133 | OH | N | Nursing Service Providers | Registered Nurse |
No ID Information.