Healthcare Provider Details

I. General information

NPI: 1578855946
Provider Name (Legal Business Name): HEIDI E NISLY CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 W RED ROCK RD
PARTRIDGE KS
67566-9042
US

IV. Provider business mailing address

9101 W RED ROCK RD
PARTRIDGE KS
67566-9042
US

V. Phone/Fax

Practice location:
  • Phone: 620-899-2866
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99096
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: