| Doctor Name: | LORA NISSEN |
| NPI Number: | 1720416589 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 0024171207 |
| Business Practice Address: | 4830 Rucker Rd Moneta, VA - 241215281 |
| Business Phone Number: | 5402977181 |
| Business Fax Number: | |
| Mailing Address: | 100 Leeward Dr, MONETA |
| State: | VA |
| Postal Code: | 241212411 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/14/2013 |
| NPI Last Update Date: | 10/14/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0024171207 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |