Provider Demographics
NPI:1003544719
Name:CISSE, AISSATOU (FNP-C)
Entity Type:Individual
Prefix:
First Name:AISSATOU
Middle Name:
Last Name:CISSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-6942
Mailing Address - Country:US
Mailing Address - Phone:508-761-5650
Mailing Address - Fax:
Practice Address - Street 1:562 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SOUTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-6942
Practice Address - Country:US
Practice Address - Phone:508-761-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2357257163W00000X
RI57764163W00000X
MARN2357257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse