Provider Demographics
NPI:1700859519
Name:BECK, LISA M (MPA S)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BECK
Suffix:
Gender:F
Credentials:MPA S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 S 80TH AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3253
Mailing Address - Country:US
Mailing Address - Phone:402-504-3707
Mailing Address - Fax:402-504-3714
Practice Address - Street 1:17675 WELCH PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3551
Practice Address - Country:US
Practice Address - Phone:402-354-7610
Practice Address - Fax:402-354-7615
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE813363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025464000Medicaid
S73955Medicare UPIN
NE099099015Medicare PIN