Provider Demographics
NPI:1649028887
Name:ENGEBRETSON, MARCY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:ENGEBRETSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5329 CAMDEN CT
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-1337
Mailing Address - Country:US
Mailing Address - Phone:715-896-1192
Mailing Address - Fax:
Practice Address - Street 1:4606 COMMERCE VALLEY RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7074
Practice Address - Country:US
Practice Address - Phone:715-828-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15021363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health