Provider Demographics
NPI:1972619062
Name:SASSE, MARY JOYCE K (DNP APRN PMHNP-BC PM)
Entity type:Individual
Prefix:DR
First Name:MARY JOYCE
Middle Name:K
Last Name:SASSE
Suffix:
Gender:F
Credentials:DNP APRN PMHNP-BC PM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 PACIFIC ST STE 3
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-5480
Mailing Address - Country:US
Mailing Address - Phone:402-916-5206
Mailing Address - Fax:402-169-5291
Practice Address - Street 1:7701 PACIFIC ST STE 3
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-5480
Practice Address - Country:US
Practice Address - Phone:402-916-5206
Practice Address - Fax:402-916-5291
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110527363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0719278Medicaid
NE85501OtherBCBS
281806OtherMEDICARE PTAN
NE85501OtherBCBS