Provider Demographics
NPI:1669359576
Name:LISCOMB, RUSSELL ELISHA
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ELISHA
Last Name:LISCOMB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15418 WEIR ST # 317
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-5045
Mailing Address - Country:US
Mailing Address - Phone:402-991-9709
Mailing Address - Fax:402-986-9699
Practice Address - Street 1:5525 HARTMAN AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-1751
Practice Address - Country:US
Practice Address - Phone:402-991-9709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist