Provider Demographics
NPI:1164106969
Name:SILVER SAGE PSYCHIATRY
Entity Type:Organization
Organization Name:SILVER SAGE PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISHA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VANVLEET
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP, PMHNP-BC
Authorized Official - Phone:307-288-2328
Mailing Address - Street 1:11404 W DODGE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-9603
Mailing Address - Country:US
Mailing Address - Phone:307-288-2328
Mailing Address - Fax:307-448-4606
Practice Address - Street 1:103 N 5TH ST E
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4402
Practice Address - Country:US
Practice Address - Phone:307-288-2328
Practice Address - Fax:307-448-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty