Provider Demographics
NPI:1013224708
Name:DE NYSSCHEN, MARIA C
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:C
Last Name:DE NYSSCHEN
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 1:2424 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-1226
Mailing Address - Country:US
Mailing Address - Phone:805-239-3208
Mailing Address - Fax:805-239-1878
Practice Address - Street 1:2424 SPRING ST
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-1226
Practice Address - Country:US
Practice Address - Phone:805-239-3208
Practice Address - Fax:805-239-1878
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist