Healthcare Provider Details

I. General information

NPI: 1457160319
Provider Name (Legal Business Name): LISA RENEE LAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 S 48TH ST
OMAHA NE
68157-2265
US

IV. Provider business mailing address

7310 S 48TH ST
OMAHA NE
68157-2265
US

V. Phone/Fax

Practice location:
  • Phone: 531-299-1900
  • Fax:
Mailing address:
  • Phone: 531-299-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: