Provider Demographics
NPI:1922393776
Name:BISSELL, MARIE A (APRN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:BISSELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:A
Other - Last Name:MCQUADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:9335 ELLISON AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1716
Mailing Address - Country:US
Mailing Address - Phone:402-981-1167
Mailing Address - Fax:
Practice Address - Street 1:3900 PINE LAKE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5489
Practice Address - Country:US
Practice Address - Phone:402-981-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111240363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE111240OtherNE LICENSE
IAJ133569OtherIA LICENSE