Individual
VIOLET NISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1480 8TH ST, WEST PLAINS, MO 65775-2010
(417) 256-5669
(417) 256-5699
Mailing address
1480 8TH ST, WEST PLAINS, MO 65775-2010
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017016508
TEMPORARY LICENSE
—
Enumeration date
05/31/2017
Last updated
02/12/2024
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