Basic Information
| Provider Information | |||||||||
| NPI: | 1720479843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DISSINGER | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 15TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW CUMBERLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170701311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178132744 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | LEMOYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170431168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179090520 | ||||||||
| FaxNumber: | 7179094676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2015 | ||||||||
| LastUpdateDate: | 10/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP014491 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 103001541 | 05 | PA | MEDICAID |