Healthcare Provider Details

I. General information

NPI: 1003544719
Provider Name (Legal Business Name): AISSATOU CISSE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 WASHINGTON ST
SOUTH ATTLEBORO MA
02703-6942
US

IV. Provider business mailing address

562 WASHINGTON ST
SOUTH ATTLEBORO MA
02703-6942
US

V. Phone/Fax

Practice location:
  • Phone: 508-761-5650
  • Fax:
Mailing address:
  • Phone: 508-761-5650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2357257
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number57764
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2357257
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: