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NPI Code Detail

MEDICARE: MARISHA LEE VANVLEET APRN-CNP, PMHNP-BC

MEDICARE: MARISHA LEE VANVLEET APRN-CNP, PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner114001NE
2364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist32026WY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
148489OTHERWYLICENSE
2114001OTHERNE2ND APRN LICENS

General Provider Information

NPI Number : 1730856147
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISHA LEE VANVLEET APRN-CNP, PMHNP-BC
Provider Business Mailing Address
First Line : 11404 W DODGE RD STE 300
Second Line :
City : OMAHA
State : NE
Zip : 68154-9603
Country : US
Telephone Number : 307-228-2328
Fax Number : 833-581-2421
Provider Business Practice Location Address
First Line : 11404 W DODGE RD STE 300
Second Line :
City : OMAHA
State : NE
Zip : 68154-9603
Country : US
Telephone Number : 402-898-1113
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2021
Last Update Date : 12/18/2025

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