Provider Demographics
NPI:1205534823
Name:HASSELL, NINA CHARISSA (NP)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:CHARISSA
Last Name:HASSELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:CHARISSA
Other - Last Name:DYKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7342 BAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AL
Mailing Address - Zip Code:35022-7218
Mailing Address - Country:US
Mailing Address - Phone:205-475-2739
Mailing Address - Fax:
Practice Address - Street 1:4700 RICE MINE RD NE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2647
Practice Address - Country:US
Practice Address - Phone:205-614-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-174590163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse