Provider Demographics
NPI:1164202339
Name:MISE, SYLVIA (FNP-C)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:MISE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 PROSPECT PL # 3
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-2914
Mailing Address - Country:US
Mailing Address - Phone:781-724-7517
Mailing Address - Fax:
Practice Address - Street 1:312 OLSON DR STE 101
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2981
Practice Address - Country:US
Practice Address - Phone:402-933-6300
Practice Address - Fax:402-916-5078
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114961363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily