Individual
MRS. CAROL LYNN HISSIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
761 STATE ROUTE 369 LOT 49, PORT CRANE, NY 13833-1033
(697) 648-9391
Mailing address
761 STATE ROUTE 369 LOT 49, PORT CRANE, NY 13833-1033
(697) 648-9391
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
10275094
NY
Other
Enumeration date
01/30/2012
Last updated
01/30/2012
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