Provider Demographics
NPI:1659883940
Name:NYAM, CLARISSE
Entity Type:Individual
Prefix:
First Name:CLARISSE
Middle Name:
Last Name:NYAM
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 1:1250 MISTY LAKE LN
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1184
Mailing Address - Country:US
Mailing Address - Phone:513-310-7597
Mailing Address - Fax:
Practice Address - Street 1:6722 STATE ROUTE 132 STE A
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:OH
Practice Address - Zip Code:45122-9346
Practice Address - Country:US
Practice Address - Phone:513-575-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020593363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care