Doctor Name: | MALISSA BISE |
NPI Number: | 1023448115 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN-CNP |
License Number: | 81511 |
Business Practice Address: | 26300 S Highway 125 Afton, OK - 743316282 |
Business Phone Number: | 9182578585 |
Business Fax Number: | 9182578561 |
Mailing Address: | 26300 S Highway 125, AFTON |
State: | OK |
Postal Code: | 743316282 |
Phone Number: | 9182578585 |
Fax Number: | 9182578561 |
NPI Enumeration Date: | 11/26/2013 |
NPI Last Update Date: | 08/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 81511 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |