Doctor Name: | MS. STEPHANIE WISBY NISSEN |
NPI Number: | 1063638484 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 5130 |
Business Practice Address: | 142 S Main St Graham, NC - 272532808 |
Business Phone Number: | 3362140709 |
Business Fax Number: | 3369319385 |
Mailing Address: | 7017 Mcgowan Creek Road, EFLAND |
State: | NC |
Postal Code: | 27243 |
Phone Number: | 9197326214 |
Fax Number: | |
NPI Enumeration Date: | 04/17/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 5130 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |