Individual
SHAWN KISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
222 PIEDMONT AVE, SUITE 4000, CINCINNATI, OH 45219-4231
(513) 475-8521
Mailing address
PO BOX 636256, CENTRAL CREDENTIALING, CINCINNATI, OH 45263-6256
(513) 245-3104
(513) 585-5511
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.313227
OH
363LA2100X
Acute Care Nurse Practitioner
Primary
COA.16198-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0109068
—
OH
Enumeration date
07/12/2014
Last updated
06/23/2017
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