Individual
JOHN FRANKLIN NISWONGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGNP-C
Contact information
Practice address
861 CANYON TRL, JACKSON, MO 63755-4001
(573) 837-2390
Mailing address
861 CANYON TRL, JACKSON, MO 63755-4001
(573) 837-2390
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2020034604
MO
Other
Enumeration date
10/28/2020
Last updated
10/28/2020
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