Healthcare Provider Details

I. General information

NPI: 1225892078
Provider Name (Legal Business Name): MARISSA LEE VOGT APRN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N COTNER BLVD
LINCOLN NE
68505-2339
US

IV. Provider business mailing address

33726 ADAMS ST
ELMWOOD NE
68349-2062
US

V. Phone/Fax

Practice location:
  • Phone: 402-466-1012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number115209
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: