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Individual

MARY NISSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
328 N SHADDLE AVE, MUNDELEIN, IL 60060-2411
(847) 566-9860
(847) 566-9861
Mailing address
1932 W CRYSTAL ST, UNIT 2, CHICAGO, IL 60622-3132
(847) 784-9115
(847) 784-9330

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
056-007166
IL

Other

Enumeration date
12/17/2009
Last updated
12/17/2009
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