MEDICARE: LISA S GENTES APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	110397	NE

General Provider Information

NPI Number	:	1548270945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA S GENTES APRN

Provider Business Mailing Address
First Line	:	PO BOX 642117
Second Line	:	SUITE 103
City	:	OMAHA
State	:	NE
Zip	:	68164-8117
Country	:	US
Telephone Number	:	402-398-6254
Fax Number	:	402-829-8513

Provider Business Practice Location Address
First Line	:	5014 L ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68117-1329
Country	:	US
Telephone Number	:	402-733-4433
Fax Number	:	402-733-1220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	01/21/2015

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