Nissen, Jacqueline S
Nissen, Jacqueline S is an individual health care provider with primary practice located at 263 Farmington Ave , Farmington CT 06030-1921. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Nissen, Jacqueline S can be contacted via phone (860) 679-4477.Contact Information
Primary practice address
263 Farmington Ave
Farmington CT 06030-1921
Phone: (860) 679-4477
Fax: (860) 679-1025
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 032545 | Connecticut |
Profile Details
| NPI number | 1053318618 |
|---|---|
| LBN Legal business name | Nissen, Jacqueline S |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 28th, 2005 |
| Last updated | Jul 11th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053318618 | NPPES |
| Connecticut | MEDICAID | 1325457 |
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