Individual
AMY J NISSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
111 S FRONT ST, HARRISBURG, PA 17101-2010
(717) 782-3380
Mailing address
111 S FRONT ST, HARRISBURG, PA 17101-2010
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA053531
PA
363AM0700X
Medical Physician Assistant
OA002306
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103146807
—
PA
Enumeration date
09/05/2008
Last updated
04/15/2021
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