Healthcare Provider Details

I. General information

NPI: 1356113625
Provider Name (Legal Business Name): MARISSA KAY JEWEL LUNDEEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 01/17/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 SENIOR CIRCLE
MACY NE
68039-3023
US

IV. Provider business mailing address

550 KEMON DR
SOUTH SIOUX CITY NE
68776-4540
US

V. Phone/Fax

Practice location:
  • Phone: 402-837-5381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number115044
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA176263
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: