# MARY KAY NISSEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1659604403
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | A-076138 | IA | Yes |

## Other

- **Enumeration date:** 09/11/2009
- **Last updated:** 10/03/2023