Provider Demographics
NPI:1700901477
Name:MLNARIK, LISA LORRAINE (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LORRAINE
Last Name:MLNARIK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LORRAINE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51415 851ST RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:NE
Mailing Address - Zip Code:68726-5273
Mailing Address - Country:US
Mailing Address - Phone:402-340-0462
Mailing Address - Fax:
Practice Address - Street 1:110 N 29TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4424
Practice Address - Country:US
Practice Address - Phone:402-844-8284
Practice Address - Fax:402-644-7505
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE54950163W00000X
NE110462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025561900Medicaid