Provider Demographics
NPI:1467188003
Name:BLISSENBACH, CARRIE ANNE (WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ANNE
Last Name:BLISSENBACH
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEBARTOLO PL STE 200
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6095
Mailing Address - Country:US
Mailing Address - Phone:330-729-8145
Mailing Address - Fax:330-965-5229
Practice Address - Street 1:1651 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6600
Practice Address - Country:US
Practice Address - Phone:234-287-9334
Practice Address - Fax:330-394-6900
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031963363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00007914Medicaid