Provider Demographics
NPI:1558300830
Name:MANSUR, LISA I (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:I
Last Name:MANSUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 PLANTATION DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4712
Mailing Address - Country:US
Mailing Address - Phone:402-328-8863
Mailing Address - Fax:402-328-8078
Practice Address - Street 1:3401 PLANTATION DR
Practice Address - Street 2:SUITE 160
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4712
Practice Address - Country:US
Practice Address - Phone:402-328-8863
Practice Address - Fax:402-328-8078
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE20419207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025031300Medicaid
NEP00057124OtherRAILROAD MEDICARE
P00057124OtherRR MEDICARE
NE10025031300Medicaid
NEG34324Medicare UPIN
277057Medicare PIN
NEP00057124OtherRAILROAD MEDICARE