Provider Demographics
NPI:1992153688
Name:EBEL, MARISSA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:EBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4282
Mailing Address - Country:US
Mailing Address - Phone:402-483-3755
Mailing Address - Fax:402-483-3776
Practice Address - Street 1:2222 S 16TH ST STE 435
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3793
Practice Address - Country:US
Practice Address - Phone:402-476-1455
Practice Address - Fax:402-476-1670
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112030363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily