Provider Demographics
NPI:1962635227
Name:MERBOTH, MARCIA K (APRN)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:K
Last Name:MERBOTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:5715 S 34TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6648
Mailing Address - Country:US
Mailing Address - Phone:402-926-2680
Mailing Address - Fax:402-926-2347
Practice Address - Street 1:8710 FREDERICK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-926-2680
Practice Address - Fax:402-926-2347
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2012-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NEIN PROCESS363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100251379-00Medicaid
01942 GROUPOtherBLUE SHIELD OF NEBRASKA