Provider Demographics
NPI:1790937258
Name:NISSEN, CHERYL A (BS RN)
Entity Type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:A
Last Name:NISSEN
Suffix:
Gender:F
Credentials:BS RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 WRIGHT ST APT 105
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1114
Mailing Address - Country:US
Mailing Address - Phone:508-813-1280
Mailing Address - Fax:
Practice Address - Street 1:431 WRIGHT ST APT 105
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1114
Practice Address - Country:US
Practice Address - Phone:508-813-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO161308163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse