Provider Demographics
NPI:1972300465
Name:MCNISH, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MCNISH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 VERONA AVE
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:NE
Mailing Address - Zip Code:68869-1017
Mailing Address - Country:US
Mailing Address - Phone:308-279-6051
Mailing Address - Fax:
Practice Address - Street 1:816 VERONA AVE
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:NE
Practice Address - Zip Code:68869-1017
Practice Address - Country:US
Practice Address - Phone:308-279-6051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker