NPI 1043659980

Kenneth William Nissen, ANP

Practitioner Adult Health Nurse Practitioner Port Jefferson, NY

Practice location

Address: 75 N Country Rd, Port Jefferson, NY 11777-2119
Phone: (631) 476-2786
Mailing address: 25 Wiltshire Dr, Commack, NY 11725-3330

Registered specialties

Adult Health Nurse Practitioner Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363LA2200X Licence 306258 (NY)

Other Nurse Practitioner providers in New York →

Registry record

NPI: 1043659980
Entity type: Individual
Sex (as registered): Male
NPI issued: 24 Jun 2013
Record last updated: 24 Jun 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.