Individual provider · Type 1 NPI

Nicole Renee Nissen

Family Nurse Practitioner · Waterloo, IL

NPI number 1629569843 Active

Practice location

623 Hamacher St
Waterloo, IL 62298-1786

Mailing address

10426 Baur Blvd
St. Louis, MO 63132-1905

Specialties and licenses

TaxonomyCodeLicense
Nurse Practitioner 363L00000X209017442 (IL)
Family Nurse Practitioner Primary 363LF0000X2018012260 (MO)

Family Nurse Practitioner: Definition to come...

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About NPI 1629569843

Nicole Renee Nissen's National Provider Identifier is 1629569843, issued on May 23, 2018. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Waterloo, IL. The record was last updated on Apr 17, 2025.