Healthcare Provider Details

I. General information

NPI: 1649071069
Provider Name (Legal Business Name): LISA MEHLIN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13919 S PLZ
OMAHA NE
68137-2916
US

IV. Provider business mailing address

3616 S 104TH ST
OMAHA NE
68124-3604
US

V. Phone/Fax

Practice location:
  • Phone: 402-698-9812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: