Individual
MR. RICK LEE NISSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8714 LYNDALE AVE S, MINNEAPOLIS, MN 55420-2738
(952) 948-9695
(952) 948-9086
Mailing address
8714 LYNDALE AVE S, MINNEAPOLIS, MN 55420-2738
(952) 948-9695
(952) 948-9086
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
30501
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
397082500
—
MN
Enumeration date
06/22/2005
Last updated
02/25/2013
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