Provider Demographics
NPI:1639308893
Name:DEGEN, LISA C (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:DEGEN
Suffix:
Gender:F
Credentials:PA-C
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 9802
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-9802
Mailing Address - Country:US
Mailing Address - Phone:308-381-0162
Mailing Address - Fax:308-389-4445
Practice Address - Street 1:3563 PRAIRIEVIEW ST STE 300
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4442
Practice Address - Country:US
Practice Address - Phone:308-381-0162
Practice Address - Fax:308-389-4445
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1453363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE24179OtherBCBS
NE24179OtherBCBS
NE095928011Medicare PIN