MICHAEL D NISSEN (NPI# 1417077827) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417077827 |
| Entity Type | Individual |
| Full Name | MICHAEL D NISSEN |
| Credential | N.P.-C |
| Practice Address |
313 Teal Dr Raeford NC 28376-2567 |
| Mailing Address |
Po Box 843013 Boston MA 02284-3013 |
| Practice Telephone | 9109042350 |
| Practice Fax Number | 9109041037 |
| Mailing Telephone | 9109042350 |
| Mailing Fax Number | 9109041037 |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2014-10-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
242756 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
1061217 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7004922 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609875442 | Michael Nissen | Ophthalmology | 1317 3rd Ave, First Floor, New York, NY 10021-2995 | 2005-07-14 |
| Street Address |
313 TEAL DR |
| City | RAEFORD |
| State | NC |
| Zip Code | 28376-2567 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790775690 | Garnett Marcus Lowry | Family Medicine | 313 Teal Dr, Raeford, NC 28376-2527 | 2005-10-24 |
| 1851888747 | Heather Whitmire | Physical Therapist | 313 Teal Dr, Raeford, NC 28376-2567 | 2018-04-17 |
| 1295141661 | Zena Kobaissi | Physician Assistant | 313 Teal Dr, Raeford, NC 28376-2567 | 2014-07-07 |
| 1073855870 | Southern Pines Womens Health Center PC | Obstetrics & Gynecology | 313 Teal Dr, Suite 1, Raeford, NC 28376-2567 | 2013-03-20 |
| 1275714636 | Pinehurst Surgical Clinic Pa | Surgery | 313 Teal Dr, Raeford, NC 28376-2527 | 2007-11-14 |
| 1760572473 | Mary J Stemen-gallagher | Nurse Practitioner | 313 Teal Dr, Raeford, NC 28376-2527 | 2006-10-13 |
| 1245335066 | Fhpg, LLC | Family Medicine | 313 Teal Dr, Raeford, NC 28376-2527 | 2006-09-14 |
| 1225028129 | Robert Glen Townsend IIi | Family Medicine | 313 Teal Dr, Raeford, NC 28376-2527 | 2005-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578185104 | Elite Supply Services, Inc. | Durable Medical Equipment & Medical Supplies | 2148 Bus-us 401, Raeford, NC 28376 | 2020-05-18 |
| 1205485695 | Brenda P Gregorio | Technician | 297 Gregorios Ln, Raeford, NC 28376 | 2019-09-09 |
| 1083197115 | Jennifer Picerno Bowyer | Nurse Practitioner | 929 Prospect Ave., Raeford, NC 28376 | 2018-09-14 |
| 1730694746 | Embassy Health Network | Counselor | 2148 Hwy 401 Business, Raeford, NC 28376 | 2017-12-13 |
| 1508398991 | Rockfish Pharmacy Inc | Pharmacy | 221 Flagstone Lane, Raeford, NC 28376 | 2017-04-03 |
| 1205281235 | William Fiebig | Nurse Practitioner | Hoke Hospital, 210 Medical Pavilion Drive, Raeford, NC 28376 | 2016-04-27 |
| 1306200647 | Tia Hart Community Recovery Program | Community/Behavioral Health | 2188 A Us 401 Business, Raeford, NC 28376 | 2016-04-13 |
| 1508240631 | Integrated Mental Health Services Agency Inc | Community/Behavioral Health | 2188-a Hwy 401 Business, Raeford, NC 28376 | 2015-07-18 |
| 1649658287 | Divine Medical Supplies Inc | Durable Medical Equipment & Medical Supplies | 320 Birch St, Raeford, NC 28376 | 2015-05-15 |
| 1992192298 | David Abdulhaqq | Counselor | 225 Aggies Lane, Raeford, NC 28376 | 2015-04-24 |
| Find all providers in zip 28376 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700404084 | Sharee Nacole Walker | Nurse Practitioner | 401 Stonewall St, Raeford, NC 28376-5983 | 2020-07-13 |
| 1194347922 | Nicayla Sonji Polanco | Nurse Practitioner | 108 Ten Acres Trl, Raeford, NC 28376-9672 | 2020-05-14 |
| 1144864653 | Lisa Michelle Meredith | Nurse Practitioner | 277 Bayleaf Dr, Raeford, NC 28376-7799 | 2019-10-29 |
| 1083197115 | Jennifer Picerno Bowyer | Nurse Practitioner | 929 Prospect Ave., Raeford, NC 28376 | 2018-09-14 |
| 1154874543 | Meghan Andrea Kohl | Nurse Practitioner | 929 Prospect Avenue, Raeford, NC 28376-9543 | 2016-08-02 |
| 1366468738 | Amy Gaweda | Nurse Practitioner | 6322 Fayetteville Rd, Raeford, NC 28376-7979 | 2006-07-15 |
| 1083603096 | Kathy Sanders Settle | Nurse Practitioner | 300 Birch St, Ste B, Raeford, NC 28376-3297 | 2005-10-21 |
| 1356816854 | Chelcie Kaluzny | Nurse Practitioner | 102 W Southern Ave, Raeford, NC 28376-3218 | 2018-10-11 |
| 1073015988 | Gladys Nyambura Dorsey | Nurse Practitioner | 683 E Palmer St, Raeford, NC 28376-6648 | 2018-03-06 |
| 1154865251 | Katasha Jarrin | Nurse Practitioner | 300 Birch St, Raeford, NC 28376-3297 | 2016-12-07 |
| Find all providers in RAEFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.