Individual
JUSTIN DOUGLAS NISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
4840 DODGE ST, OMAHA, NE 68132-3111
(402) 558-2000
Mailing address
7261 MERCY RD, OMAHA, NE 68124-2311
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
75939
NE
363LF0000X
Family Nurse Practitioner
Primary
112354
NE
Other
Enumeration date
10/05/2017
Last updated
11/23/2021
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