MEDICARE: LISA D FREEMAN CRNA

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	367500000X	Certified Registered Nurse Anesthetist	100512	NE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00268425	OTHER	NE	RAILROAD MEDICARE
2	P00410481	OTHER	NE	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	36435	OTHER	NE	BCBS
4	38073	OTHER	NE	BCBS

General Provider Information

NPI Number	:	1871547539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA D FREEMAN CRNA

Provider Business Mailing Address
First Line	:	PO BOX 3592
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68103-0592
Country	:	US
Telephone Number	:	605-335-1952
Fax Number	:	605-373-9971

Provider Business Practice Location Address
First Line	:	3772 43RD AVE STE B
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-1681
Country	:	US
Telephone Number	:	605-335-1952
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	06/25/2020

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Directions to “ LISA D FREEMAN CRNA” Practice Location

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