Provider Demographics
NPI:1912407487
Name:HISSOM, HEATHER (WHNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HISSOM
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 645409
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15264-5252
Mailing Address - Country:US
Mailing Address - Phone:330-386-6442
Mailing Address - Fax:330-386-3660
Practice Address - Street 1:16761 SAINT CLAIR AVE STE 2
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9400
Practice Address - Country:US
Practice Address - Phone:330-385-9670
Practice Address - Fax:330-385-9672
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH104411348363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health