1154432722 NPI number — MS. LISA R WHITE DPT

Table of content: MS. LISA R WHITE DPT (NPI 1154432722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154432722 NPI number — MS. LISA R WHITE DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
LISA
Provider Middle Name:
R
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PILLE
Provider Other First Name:
LISA
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154432722
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6404 NORTH 70TH PLAZA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-573-3700
Provider Business Mailing Address Fax Number:
402-573-3790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2102 HARVELL CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-293-5500
Provider Business Practice Location Address Fax Number:
402-293-5505
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2271 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)