Provider Demographics
NPI:1720479843
Name:DISSINGER, DONALD JAMES (CRNP)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JAMES
Last Name:DISSINGER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 15TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-1311
Mailing Address - Country:US
Mailing Address - Phone:717-813-2744
Mailing Address - Fax:
Practice Address - Street 1:3 WALNUT ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1168
Practice Address - Country:US
Practice Address - Phone:717-909-0520
Practice Address - Fax:717-909-4676
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103001541Medicaid
PA103001541Medicaid