Provider Demographics
NPI:1093055782
Name:KRISCHEL, MARIELLEN E (APN)
Entity Type:Individual
Prefix:
First Name:MARIELLEN
Middle Name:E
Last Name:KRISCHEL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-467-6789
Mailing Address - Fax:319-467-7400
Practice Address - Street 1:3640 MIDDLEBURY RD
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2712
Practice Address - Country:US
Practice Address - Phone:319-467-6789
Practice Address - Fax:319-467-7400
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-010374363LF0000X
IAA170330363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL436860136Medicare PIN