Nicole Nissen
Nicole Nissen is a Family Nurse Practitioner in Waterloo, IL, registered under NPI 1629569843. This provider registers 2 separate taxonomy codes, which usually means they practise across more than one recognised specialty.
Getting there
The practice address on file is 623 HAMACHER ST, Waterloo, IL 62298. We have not yet mapped what surrounds this office — parking, transit, and nearby pharmacies are added as our data collection reaches each location.
Credentials and Medicare
| Licence | State | Specialty |
|---|---|---|
| 2018012260 | MO | Family Nurse Practitioner primary |
| 209017442 | IL | Nurse Practitioner |
Licences are recorded in 2 states: MO, IL. Providers licensed in several states often practise near a state border or deliver telehealth across state lines.
- Status
- Approved
- Provider type
- Practitioner - Nurse Practitioner
- PAC ID
- 0547519423
Medicare enrolment is recorded as approved under the provider type Practitioner - Nurse Practitioner. This means the provider is enrolled to bill Medicare, though it does not tell you whether they are currently accepting new Medicare patients. Call the office to confirm.
Licensed in 2 states
This provider holds licences in 2 states: Illinois and Missouri. The practice address on file is in Waterloo, IL, but a licence in another state usually means they see patients there too — either at a second location or by telehealth. If the address above is far from you, it is worth calling to ask whether they practise closer to where you live.
- Licence
- 209017442
- Specialty
- Nurse Practitioner
Licence numbers are self-reported to NPPES at registration. They do not confirm a licence is currently active, in good standing, or valid for the specialty shown — only the state board can tell you that, which is why we link to each one.
What Family covers
Definition to come... NUCC Health Care Provider Taxonomy, code 363LF0000X
All registered taxonomy codes
This provider registers 2 taxonomy codes. The primary code is what appears on most claims; the others record additional recognised specialties.
| Code | Specialty | Licence | State | |
|---|---|---|---|---|
| 363LF0000X | Family Nurse Practitioner Family | 2018012260 | MO | primary |
| 363L00000X | Nurse Practitioner | 209017442 | IL |
The taxonomy records how the provider classifies their own practice. It does not confirm which conditions they currently treat, whether they are accepting new patients, or which insurance they take — call the office for that.
Full NPPES record
An NPI-1 identifies a single person. It stays with the clinician for life, even if they move practice or change state, which is why the address on file can lag behind where they actually work today.
| NPI | 1629569843 valid check digit |
|---|---|
| Entity type | Individual (NPI-1) |
| Enumeration date | May 23, 2018 |
| Last updated | Apr 17, 2025 |
| Status | Active |
| Sole proprietor | No |
| Practice address |
623 HAMACHER ST Waterloo, IL 62298 (314) 925-0903 |
| Mailing address |
10426 BAUR BLVD Saint Louis, MO 63132 |
Number check
How the check works, step by step
Every NPI carries a Luhn check digit — the same scheme used on credit cards. CMS prefixes the number with 80840 before computing it, which marks it as a US health identifier.
| Digit | 8 | 0 | 8 | 4 | 0 | 1 | 6 | 2 | 9 | 5 | 6 | 9 | 8 | 4 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Doubled? | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 |
| Value | 8 | 0 | 8 | 8 | 0 | 2 | 6 | 4 | 9 | 1 | 6 | 9 | 8 | 8 |
Sum = 77 · next multiple of 10 = 80 · check digit = 3 · actual last digit = 3
A valid check digit only means the number is well-formed. It does not mean the provider is licensed, active, or in good standing — those are separate questions answered by the sections above.