Individual
LORA NISSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
4830 RUCKER RD, MONETA, VA 24121-5281
(540) 297-7181
Mailing address
100 LEEWARD DR, MONETA, VA 24121-2411
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024171207
VA
Other
Enumeration date
10/14/2013
Last updated
10/14/2013
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