Provider Demographics
NPI:1629374822
Name:NISSLEY, KATHLEEN M (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:NISSLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 HARRISBURG AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2964
Mailing Address - Country:US
Mailing Address - Phone:717-397-5484
Mailing Address - Fax:717-397-8407
Practice Address - Street 1:217 HARRISBURG AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2964
Practice Address - Country:US
Practice Address - Phone:717-397-5484
Practice Address - Fax:717-397-8407
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily