Provider Demographics
NPI:1245574714
Name:NISA INCORPORATED
Entity type:Organization
Organization Name:NISA INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAYLA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:RUBBANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-412-9728
Mailing Address - Street 1:P.O. BOX 18488
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218
Mailing Address - Country:US
Mailing Address - Phone:262-412-9728
Mailing Address - Fax:
Practice Address - Street 1:10213A W FOND DU LAC AVE
Practice Address - Street 2:128
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-5171
Practice Address - Country:US
Practice Address - Phone:262-412-9728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty