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NPI Code Detail

MEDICARE: JENNIFER L NISSENBAUM

MEDICARE: JENNIFER L NISSENBAUM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse9019613-3102UT

General Provider Information

NPI Number : 1326901620
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER L NISSENBAUM
Provider Business Mailing Address
First Line : 8117 COURTYARD LOOP APT 12
Second Line :
City : PARK CITY
State : UT
Zip : 84098-4768
Country : US
Telephone Number : 614-581-2325
Fax Number :
Provider Business Practice Location Address
First Line : 8117 COURTYARD LOOP APT 12
Second Line :
City : PARK CITY
State : UT
Zip : 84098-4768
Country : US
Telephone Number : 614-581-2325
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2025
Last Update Date : 12/04/2025

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Directions to “ JENNIFER L NISSENBAUM ” Practice Location

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