Provider Demographics
NPI:1689902439
Name:TOMPKINS, LISA ELAINE (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ELAINE
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 IDA ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68112-2946
Mailing Address - Country:US
Mailing Address - Phone:402-455-0701
Mailing Address - Fax:
Practice Address - Street 1:819 DORCAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-1137
Practice Address - Country:US
Practice Address - Phone:402-342-4411
Practice Address - Fax:402-342-5015
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12996164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse