Provider Demographics
NPI:1780169219
Name:SORRELL, MARCELLA LOUISE (FNP)
Entity type:Individual
Prefix:DR
First Name:MARCELLA
Middle Name:LOUISE
Last Name:SORRELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-5210
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:1 EDMUNDSON PL STE 306
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4620
Practice Address - Country:US
Practice Address - Phone:712-396-4295
Practice Address - Fax:712-396-4298
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112640207Q00000X
IAA155912363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1780169219Medicaid
NE10026209700Medicaid