Individual
CHAD CISSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
2975 S RAINBOW STE J, LAS VEGAS, NV 89146
(702) 228-8520
Mailing address
12906 117TH ST E, PUYALLUP, WA 98374-5057
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN16611
NV
Other
Enumeration date
05/04/2016
Last updated
05/04/2016
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