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General NPI Number Information
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NPI Number | 1356113625
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Entity Type | Individual
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Provider Name | MARISSA KAY JEWEL LUNDEEN APRN
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Gender | Female
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 931 SENIOR CIRCLE
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City | MACY
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State | NE
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Zip | 68039-3023
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Country | US
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Telephone | 402-837-5381
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Fax |
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Provider Business Mailing Address
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Address Line | 550 KEMON DR
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City | SOUTH SIOUX CITY
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State | NE
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Zip | 68776-4540
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 115044
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A176263
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License Number State | IA
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