Healthcare Provider Details

I. General information

NPI: 1538246046
Provider Name (Legal Business Name): MARISSA HEUER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 CORNHUSKER HWY STE 600
LINCOLN NE
68504-1599
US

IV. Provider business mailing address

3940 CORNHUSKER HWY STE 600
LINCOLN NE
68504-1599
US

V. Phone/Fax

Practice location:
  • Phone: 402-326-9850
  • Fax: 402-477-3655
Mailing address:
  • Phone: 402-326-9850
  • Fax: 402-477-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number110774
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: