Healthcare Provider Details

I. General information

NPI: 1205482403
Provider Name (Legal Business Name): MARISA CHRISTINE WIESELER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISA CHRISTINE VALDES APRN

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 W CENTER RD STE 200
OMAHA NE
68124-2388
US

IV. Provider business mailing address

7205 W CENTER RD STE 200
OMAHA NE
68124-2388
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-6600
  • Fax: 402-397-8318
Mailing address:
  • Phone: 402-397-6600
  • Fax: 402-397-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11003263
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11003263
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10150
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number115237
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: