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Individual
NETTIE RUTH MISTIC
Active
Individual
NETTIE RUTH MISTIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
I.0001796
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000387062
ANTHEM BCBS
OH
01
—
I 0001796
LICENSE NUMBER
OH
Enumeration date
02/10/2006
Last updated
07/08/2007
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