Provider Demographics
NPI:1285498634
Name:SIERRA, MARESA LORENE (APRN)
Entity type:Individual
Prefix:
First Name:MARESA
Middle Name:LORENE
Last Name:SIERRA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARESA
Other - Middle Name:LORENE
Other - Last Name:HORNBAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2412 CUMING ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1604
Mailing Address - Country:US
Mailing Address - Phone:402-717-0380
Mailing Address - Fax:
Practice Address - Street 1:6901 N 72ND ST STE 3100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1752
Practice Address - Country:US
Practice Address - Phone:402-572-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA178067363L00000X
NE115193363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner