1023063146 NPI number — MS. ANNE M. LISKA PA-C

Table of content: MS. ANNE M. LISKA PA-C (NPI 1023063146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023063146 NPI number — MS. ANNE M. LISKA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LISKA
Provider First Name:
ANNE
Provider Middle Name:
M.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAMBERT
Provider Other First Name:
ANNE
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023063146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 E DECATUR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST POINT
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68788-1566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-372-2404
Provider Business Mailing Address Fax Number:
402-372-6770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 21ST CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WISNER
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68791-2045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-529-6516
Provider Business Practice Location Address Fax Number:
402-529-6530
Provider Enumeration Date:
05/24/2006

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: 363AM0700X , with the licence number:  458 , 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)





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