Healthcare Provider Details

I. General information

NPI: 1124470273
Provider Name (Legal Business Name): DANIELLE NICOLE WISSMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE NICOLE FISCHER RN

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3906 PEACHTREE DR
COLUMBIA MO
65203-4925
US

IV. Provider business mailing address

23850 ANDERSON SCHOOL RD
SEDALIA MO
65301-0806
US

V. Phone/Fax

Practice location:
  • Phone: 573-256-6506
  • Fax:
Mailing address:
  • Phone: 660-221-4878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026044294
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: