Healthcare Provider Details

I. General information

NPI: 1306897863
Provider Name (Legal Business Name): LISA K KOLLASCH PARKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17940 WELCH PLZ STE 106
OMAHA NE
68135-3714
US

IV. Provider business mailing address

17940 WELCH PLZ STE 106
OMAHA NE
68135-3714
US

V. Phone/Fax

Practice location:
  • Phone: 402-866-8625
  • Fax:
Mailing address:
  • Phone: 402-866-8625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110524
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110524
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: