Individual
MARY KAY NISSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3303 REBECCA ST, SIOUX CITY, IA 51104-2324
(712) 279-5458
Mailing address
3303 REBECCA ST, SIOUX CITY, IA 51104-2324
(712) 279-5458
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A-076138
IA
Other
Enumeration date
09/11/2009
Last updated
10/03/2023
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