Provider Demographics
NPI:1124470273
Name:WISSMAN, DANIELLE NICOLE (RN)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:NICOLE
Last Name:WISSMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:NICOLE
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:37 LAUREL BAY DR
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31315-2838
Mailing Address - Country:US
Mailing Address - Phone:660-221-4878
Mailing Address - Fax:
Practice Address - Street 1:37 LAUREL BAY DR
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31315-2838
Practice Address - Country:US
Practice Address - Phone:660-221-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN229524163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency