Healthcare Provider Details

I. General information

NPI: 1861468092
Provider Name (Legal Business Name): MICHELE R MARSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9239 W CENTER RD SUITE 208
OMAHA NE
68124-1900
US

IV. Provider business mailing address

9239 W CENTER RD SUITE 208
OMAHA NE
68124-1900
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-8085
  • Fax: 402-354-8044
Mailing address:
  • Phone: 402-354-8085
  • Fax: 402-354-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number17276
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: