Individual
MARK A BRISSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 S 48TH ST, NEONATOLGY, LINCOLN, NE 68506-1283
(402) 481-7333
(402) 481-7579
Mailing address
2222 S 16TH ST, STE 400A, LINCOLN, NE 68502-3796
(402) 483-8590
(402) 483-8599
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
10802
NE
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
21523
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200379810A
—
KS
05
—
470780857 02
—
NE
Enumeration date
07/21/2006
Last updated
12/01/2011
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