MEDICARE: DAVID NISSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841413234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID NISSEN

Provider Business Mailing Address
First Line	:	908 N WEST AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-5722
Country	:	US
Telephone Number	:	605-367-4293
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 N WEST AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-5722
Country	:	US
Telephone Number	:	605-367-4293
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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Directions to “ DAVID NISSEN ” Practice Location

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