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NPI Code Detail

MEDICARE: NISSA HAUGEN DNP, FNP-C

MEDICARE: NISSA HAUGEN DNP, FNP-C
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
1363LF0000XFamily Nurse Practitioner29147TN
2363LF0000XFamily Nurse PractitionerRN175275GA
3163WC1500XCommunity Health Registered Nurse695600CA

General Provider Information

NPI Number : 1538380050
Entity Type Code : Individual
Provider Name (Legal Business Name) : NISSA HAUGEN DNP, FNP-C
Provider Business Mailing Address
First Line : 151 VAN HOUTEN AVE
Second Line :
City : EL CAJON
State : CA
Zip : 92020-4429
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1102 W WAUGH ST
Second Line :
City : DALTON
State : GA
Zip : 30720-8769
Country : US
Telephone Number : 277-277-2321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 08/19/2021

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