1750672846 NPI number — LISA M COLE-MAILANDER RN

Table of content: LISA M COLE-MAILANDER RN (NPI 1750672846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750672846 NPI number — LISA M COLE-MAILANDER RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE-MAILANDER
Provider First Name:
LISA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750672846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5738 S 137TH ST
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:
68137-2965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-813-4944
Provider Business Mailing Address Fax Number:
402-895-5025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5738 S 137TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68137-2965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-813-4944
Provider Business Practice Location Address Fax Number:
402-895-5025
Provider Enumeration Date:
04/25/2011

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: 163WH0200X , with the licence number:  62026 , 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)

  • Identifier: 03 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11997434 . This is a "N-FOCUS/PASS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: TAX ID . This is a "COVENTRY MEDICAID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".