KENNETH WILLIAM NISSEN

PORT JEFFERSON, NY
NPI1043659980
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363LA2200X Nurse Practitioner, Adult Health
(Licence: NY  306258)
Enumeration Date2013-06-24
Last Update Date2013-06-24
Business Address
-- KENNETH WILLIAM NISSEN ANP
75 N COUNTRY RD
PORT JEFFERSON, NY 11777-2119
Phone number: 631-476-2786
Mailing Address
-- KENNETH WILLIAM NISSEN ANP
25 WILTSHIRE DR
COMMACK, NY 11725-3330
Phone number: 516-521-0456
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