Provider Demographics
NPI:1851149983
Name:BISSENOVA, DINORA
Entity type:Individual
Prefix:
First Name:DINORA
Middle Name:
Last Name:BISSENOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12361 76TH CT NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2402
Mailing Address - Country:US
Mailing Address - Phone:360-593-7207
Mailing Address - Fax:
Practice Address - Street 1:12361 76TH CT NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2402
Practice Address - Country:US
Practice Address - Phone:360-593-7207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula