Provider Demographics
NPI:1437514395
Name:NYSSE, ERIC (RN)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:NYSSE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W198N16881 RIDGEWAY DR APT 8
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037-9692
Mailing Address - Country:US
Mailing Address - Phone:920-286-0943
Mailing Address - Fax:
Practice Address - Street 1:W198N16881 RIDGEWAY DR APT 8
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WI
Practice Address - Zip Code:53037-9692
Practice Address - Country:US
Practice Address - Phone:920-286-0943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-19
Last Update Date:2015-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI223056-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse