Basic Information
| Provider Information | |||||||||
| NPI: | 1427338201 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DISSER | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | I. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RN, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9789 WOODMILL LN | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452313725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132402079 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20265 EMERY RD | ||||||||
| Address2: | |||||||||
| City: | NORTH RANDALL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441284122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405239966 | ||||||||
| FaxNumber: | 2165842895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2011 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN.352837- | OH | N | Nursing Service Providers | Registered Nurse | 363LA2200X | COA.12749-NP | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363L00000X | APRN.CNP.12749 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 0076250 | 05 | OH | MEDICAID |