Healthcare Provider Details

I. General information

NPI: 1093403479
Provider Name (Legal Business Name): ELIZABETH CISSELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 M ST NW STE 318
WASHINGTON DC
20037-1472
US

IV. Provider business mailing address

2440 M ST NW STE 318
WASHINGTON DC
20037-1472
US

V. Phone/Fax

Practice location:
  • Phone: 202-335-4700
  • Fax:
Mailing address:
  • Phone: 202-335-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP200004130
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: