Provider Demographics
NPI:1033490297
Name:MANCHESTER, LISA MAE (APRN)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:MAE
Last Name:MANCHESTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15905 W DODGE RD
Mailing Address - Street 2:APT. 3D
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-4032
Mailing Address - Country:US
Mailing Address - Phone:402-719-4329
Mailing Address - Fax:
Practice Address - Street 1:425 N DIERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4910
Practice Address - Country:US
Practice Address - Phone:308-389-3278
Practice Address - Fax:308-382-1149
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111261363LF0000X
NE66171163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice