Healthcare Provider Details

I. General information

NPI: 1750672846
Provider Name (Legal Business Name): LISA M COLE-MAILANDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5738 S 137TH ST
OMAHA NE
68137-2965
US

IV. Provider business mailing address

5738 S 137TH ST
OMAHA NE
68137-2965
US

V. Phone/Fax

Practice location:
  • Phone: 402-813-4944
  • Fax: 402-895-5025
Mailing address:
  • Phone: 402-813-4944
  • Fax: 402-895-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number62026
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: