Provider Demographics
NPI:1063209948
Name:BIRDINE, LISA A
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:BIRDINE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 S 84TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-2116
Mailing Address - Country:US
Mailing Address - Phone:402-201-3268
Mailing Address - Fax:402-991-3117
Practice Address - Street 1:7200 S 84TH ST STE 4
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-2116
Practice Address - Country:US
Practice Address - Phone:402-201-3268
Practice Address - Fax:402-991-3117
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide