Provider Demographics
NPI:1033915475
Name:NISCAVITS, JOHN L (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:NISCAVITS
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 FAIRDALE ST
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4519
Mailing Address - Country:US
Mailing Address - Phone:713-516-2405
Mailing Address - Fax:
Practice Address - Street 1:9525 KATY FWY STE 206
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1476
Practice Address - Country:US
Practice Address - Phone:713-400-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1191530367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered