Provider Demographics
NPI:1962986620
Name:KAFKA, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KAFKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14850 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-4530
Mailing Address - Country:US
Mailing Address - Phone:402-933-3915
Mailing Address - Fax:531-299-2039
Practice Address - Street 1:14850 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-4530
Practice Address - Country:US
Practice Address - Phone:402-933-3915
Practice Address - Fax:531-299-2039
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE53960163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool