Provider Demographics
NPI:1417544990
Name:CISSE, NANAN
Entity Type:Individual
Prefix:
First Name:NANAN
Middle Name:
Last Name:CISSE
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 1:2156 HONE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1250
Mailing Address - Country:US
Mailing Address - Phone:212-690-0528
Mailing Address - Fax:
Practice Address - Street 1:1432 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4521
Practice Address - Country:US
Practice Address - Phone:646-289-7731
Practice Address - Fax:646-289-7791
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY742537-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse