Individual
JENNIFER L NISSENBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8117 COURTYARD LOOP APT 12, PARK CITY, UT 84098-4768
(614) 581-2325
Mailing address
8117 COURTYARD LOOP APT 12, PARK CITY, UT 84098-4768
(614) 581-2325
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
9019613-3102
UT
Other
Enumeration date
12/04/2025
Last updated
12/04/2025
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