Healthcare Provider Details

I. General information

NPI: 1598196974
Provider Name (Legal Business Name): DENYSE SIHAM NIZAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5429 PENNY LN
MADISON WI
53718-4418
US

IV. Provider business mailing address

5429 PENNY LN
MADISON WI
53718-4418
US

V. Phone/Fax

Practice location:
  • Phone: 720-226-4710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5596
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0003941
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number100961-875
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5596
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: