Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nicole Renee Nissen

Individual provider Nurse Practitioner · NPI 1629569843

Nicole Renee Nissen is a Nurse Practitioner in Waterloo, Illinois. Qualified in 2017, 9 years ago. Practices with Generation Clinical Partners LLC, a 24-clinician group and accepts Medicare assignment. Licensed in Illinois and Missouri.

Years since qualifying
9
Licensed in
IL, MO
In the registry since
2018
Specialties on file
2

Practice location Address checks out

623 Hamacher St
Waterloo, IL 62298-1786
Phone: (314) 925-0903
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 2018012260 (MO)
Nurse Practitioner Taxonomy 363L00000X · Licence 209017442 (IL)

Record details

NPI number1629569843
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMay 23, 2018
Last updated in NPPESApril 17, 2025
Certification dateApril 17, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Generation Clinical Partners Llc — 24 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Waterloo