Provider Demographics
NPI:1447731757
Name:NISWANDER FAMILY MEDICINE INC
Entity type:Organization
Organization Name:NISWANDER FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:NISWANDER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:931-244-7217
Mailing Address - Street 1:88 W EDAN RD
Mailing Address - Street 2:
Mailing Address - City:ETHRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:38456-5137
Mailing Address - Country:US
Mailing Address - Phone:931-829-2056
Mailing Address - Fax:931-829-2461
Practice Address - Street 1:88 W EDAN RD
Practice Address - Street 2:
Practice Address - City:ETHRIDGE
Practice Address - State:TN
Practice Address - Zip Code:38456-5137
Practice Address - Country:US
Practice Address - Phone:931-829-2056
Practice Address - Fax:931-829-2461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty