Individual
STEPHANIE D NISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, ACNP-BC
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 518-5072
Mailing address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 518-5072
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
2002016204
MO
Other
Enumeration date
04/24/2009
Last updated
04/24/2009
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