Healthcare Provider Details

I. General information

NPI: 1730856147
Provider Name (Legal Business Name): MARISHA LEE VANVLEET APRN-CNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 MAIN ST
LANDER WY
82520-3101
US

IV. Provider business mailing address

11404 W DODGE RD STE 300
OMAHA NE
68154-9603
US

V. Phone/Fax

Practice location:
  • Phone: 307-288-2328
  • Fax: 833-581-2421
Mailing address:
  • Phone: 307-228-2328
  • Fax: 833-581-2421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number32026
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number114001
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: