Individual
MS. ELAINE A. NISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1298 W FINNIE FLAT RD, CAMP VERDE, AZ 86322-5958
(928) 639-5555
(928) 639-5554
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN040303
AZ
363LF0000X
Family Nurse Practitioner
Primary
AP3425
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
454700
—
AZ
Enumeration date
08/07/2009
Last updated
05/05/2021
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