Provider Demographics
NPI:1891762407
Name:NISSEN, DAVID C (AUD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:NISSEN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19087
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66285-9087
Mailing Address - Country:US
Mailing Address - Phone:913-262-5855
Mailing Address - Fax:913-262-5869
Practice Address - Street 1:7301 MISSION RD STE 140
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3005
Practice Address - Country:US
Practice Address - Phone:913-262-5855
Practice Address - Fax:913-262-5869
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1843231H00000X
MO2019016856231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
481106646OtherHUMANA
KS100398810AMedicaid
29266014OtherBCBS OF KANSAS CITY
7306232OtherAETNA
KS1122OtherHEARING AID DISPENSING LI
P31671OtherCOVENTRY
640004510OtherTRAVELERS MEDICARE
KS1122OtherHEARING AID DISPENSING LI
D22B071Medicare ID - Type Unspecified