Provider Demographics
NPI:1992092175
Name:MARRIOTT, DARLA LEIGH (NP-C)
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:LEIGH
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:DARLA
Other - Middle Name:LEGIH
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2797
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2797
Mailing Address - Country:US
Mailing Address - Phone:402-354-4230
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:208 S 26TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131
Practice Address - Country:US
Practice Address - Phone:402-354-3198
Practice Address - Fax:402-354-3199
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112776363LF0000X, 363LF0000X
MO2011017388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026485712Medicaid
IA1992092175Medicaid
NE10025777600Medicaid