Individual
MRS. ELISA MIRANDA SISON IRISARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
119 JEFFERSON AVE, MOUNDSVILLE, WV 26041-1410
(304) 845-8555
(304) 843-1008
Mailing address
2000 EOFF ST, WHEELING, WV 26003-3823
(304) 234-8663
(304) 234-8960
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
0108761
OH
207V00000X
Obstetrics & Gynecology Physician
Primary
11087
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0094259000
—
WV
Enumeration date
10/26/2006
Last updated
10/28/2016
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