Provider Demographics
NPI:1477648749
Name:MANNSCHRECK, MARILYN J (APRN)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:MANNSCHRECK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:SEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:575 S 70TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2471
Mailing Address - Country:US
Mailing Address - Phone:402-488-3322
Mailing Address - Fax:402-488-1172
Practice Address - Street 1:575 S 70TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2471
Practice Address - Country:US
Practice Address - Phone:402-488-3322
Practice Address - Fax:402-488-1172
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110267363LA2100X, 363LA2200X
KS45117363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47070592301Medicaid
NE47070592305Medicaid
NE47070592313Medicaid
NE47070592300Medicaid
NE47070592302Medicaid
NE47070592306Medicaid
NENA1080022Medicare PIN
NE47070592306Medicaid
NE500021030Medicare PIN
NE47070592300Medicaid
NE47070592313Medicaid