Individual
TINA MARIE NISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
856 ARMOUR RD STE B, OCONOMOWOC, WI 53066-3976
(262) 569-4900
Mailing address
1141 W WISCONSIN AVE, OCONOMOWOC, WI 53066-2628
(920) 988-7971
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
11404
WI
Other
Enumeration date
08/14/2017
Last updated
08/14/2017
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