Provider Demographics
NPI:1831978568
Name:DI LEO, MARIELLA (APRN-NP)
Entity type:Individual
Prefix:
First Name:MARIELLA
Middle Name:
Last Name:DI LEO
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11807 S 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1453
Mailing Address - Country:US
Mailing Address - Phone:631-235-7111
Mailing Address - Fax:
Practice Address - Street 1:2255 S 132ND ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2573
Practice Address - Country:US
Practice Address - Phone:402-614-4969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE115030363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner