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General NPI Number Information
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NPI Number | 1649701541
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Entity Type | Individual
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Provider Name | BENJAMIN NISSEN
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Gender | Male
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 439 EDWARDS ACCESS RD
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City | EDWARDS
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State | CO
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Zip | 81632-5634
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Country | US
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Telephone | 970-445-2489
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Fax | 970-470-6510
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Provider Business Mailing Address
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Address Line | PO BOX 4330
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City | AVON
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State | CO
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Zip | 81620-4330
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Country | US
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Telephone | 970-926-6340
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Fax | 970-926-6348
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | DR.0065872
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License Number State | CO
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