Provider Demographics
NPI:1417415019
Name:HOLOUBEK, LISA ALICE (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ALICE
Last Name:HOLOUBEK
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 1:700 S KENT ST # 450
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NE
Mailing Address - Zip Code:68748-6279
Mailing Address - Country:US
Mailing Address - Phone:402-454-3336
Mailing Address - Fax:402-454-2238
Practice Address - Street 1:700 S KENT ST # 450
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NE
Practice Address - Zip Code:68748-6279
Practice Address - Country:US
Practice Address - Phone:402-454-3336
Practice Address - Fax:402-454-2238
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE50811163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool