Individual
TANNER J. NISSLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1020 W BROADWAY AVE, BROADWAY FAMILY MEDICINE, MINNEAPOLIS, MN 55411-2504
(612) 302-8209
Mailing address
1020 W BROADWAY AVE, BROADWAY FAMILY MEDICINE, MINNEAPOLIS, MN 55411-2504
(612) 302-8209
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
50925
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2008
Last updated
02/15/2013
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