Provider Demographics
NPI:1003689738
Name:FREEZE, NISSA ANN
Entity Type:Individual
Prefix:
First Name:NISSA
Middle Name:ANN
Last Name:FREEZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-2009
Mailing Address - Country:US
Mailing Address - Phone:157-027-5496
Mailing Address - Fax:
Practice Address - Street 1:507 E MARKET ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-2009
Practice Address - Country:US
Practice Address - Phone:157-027-5496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN649635163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health