Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 112097 | NE |
NPI | 1003269978 |
---|---|
Provider Name | Leah R. Lienemann |
First Address | Omaha, NE 68103-2797 |
Second Address | Omaha, NE 68114-4108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2016 |
Last Update Date | 23/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
096573088 | (02) | NE |
1003269978 | (05) | IA |
47037660432 | (05) | NE |