Provider Demographics
NPI:1750672846
Name:COLE-MAILANDER, LISA M (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:COLE-MAILANDER
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 1:5738 S 137TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2965
Mailing Address - Country:US
Mailing Address - Phone:402-813-4944
Mailing Address - Fax:402-895-5025
Practice Address - Street 1:5738 S 137TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2965
Practice Address - Country:US
Practice Address - Phone:402-813-4944
Practice Address - Fax:402-895-5025
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62026163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE03Medicaid
NE11997434OtherN-FOCUS/PASS
NETAX IDOtherCOVENTRY MEDICAID