Provider Demographics
NPI:1346536588
Name:BOEKE, LISA ANN (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BOEKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:626 N STREET
Mailing Address - City:LOUP CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68853-0509
Mailing Address - Country:US
Mailing Address - Phone:308-745-0780
Mailing Address - Fax:308-745-0446
Practice Address - Street 1:626 N ST
Practice Address - Street 2:
Practice Address - City:LOUP CITY
Practice Address - State:NE
Practice Address - Zip Code:68853-8110
Practice Address - Country:US
Practice Address - Phone:308-745-0780
Practice Address - Fax:308-745-0446
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE46215163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse