Fnu Nisina

Primary specialty

DentistTaxonomy code 122300000X

License

DE61429179 Issued in WA

Practice address

1120 W Rose St
Walla Walla, WA 99362-1662

Phone

(509) 525-6650

NPI assigned

Jul 5, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1688515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1083391684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 W ROSE ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993621662",
            "telephone_number": "509-525-0247",
            "fax_number": "509-552-2349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 W ROSE ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993621662",
            "telephone_number": "509-525-6650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISINA",
        "first_name": "FNU",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-05",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NV",
            "license": "7825",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE61429179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danelle Nick, MD
• Nielson Eye Care
• Amy L Nielson, LSWAIC
• Bradley Kyle Nielson, OD
• Trudee Kaye Nims, R.D.
• Juliet Chinwe Nnaji, RN
• Robin E Noble
• Patricia Noel, OTR
• Norco, Inc
• Jeremiah Nordstrom

• Dentist in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.