Provider Demographics
NPI:1871547539
Name:FREEMAN, LISA D (CRNA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3592
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0592
Mailing Address - Country:US
Mailing Address - Phone:605-335-1952
Mailing Address - Fax:605-373-9971
Practice Address - Street 1:3772 43RD AVE STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1681
Practice Address - Country:US
Practice Address - Phone:605-335-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100512367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00268425OtherRAILROAD MEDICARE
NEP00410481OtherRAILROAD MEDICARE
NE36435OtherBCBS
NE38073OtherBCBS
NEP00268425OtherRAILROAD MEDICARE
NEP00410481OtherRAILROAD MEDICARE