Healthcare Provider Details

I. General information

NPI: 1265365498
Provider Name (Legal Business Name): ELISE LILJA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

16923 JOANNE DR
OMAHA NE
68136-4146
US

IV. Provider business mailing address

4357 CHESTNUT LN NE
PRIOR LAKE MN
55372-1185
US

V. Phone/Fax

Practice location:
  • Phone: 402-297-3778
  • Fax:
Mailing address:
  • Phone: 952-820-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: