Individual
LAURA NISSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
825 COBBLESTONE LN, KIMBERLY, WI 54136-2116
(920) 282-6658
Mailing address
2904 E CORRIDOR DR, APPLETON, WI 54913-6722
(920) 915-9675
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5793-024
WI
Other
Enumeration date
10/16/2023
Last updated
10/16/2023
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