Mark Edward Sissell

NPI #1972159440 in Sand Lake, Michigan

Provider Information

NPI Number: 1972159440
Entity Type: Individual
Name: Mark Edward Sissell
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Foster Care Agency
Enumeration Date: Aug 12, 2019
Last Updated: Aug 12, 2019

Practice Location

Address: 8180 19 MILE RD
City: Sand Lake
State: Michigan
ZIP Code: 49343-9455
Phone: (616) 696-2304

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Foster Care Agency	253J00000X	Primary

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