Individual
MRS. JOLENE MARIE LIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5005 S 153RD ST STE 100, OMAHA, NE 68137-5070
(402) 717-1255
(402) 818-1924
Mailing address
7261 MERCY RD, OMAHA, NE 68124-2311
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
111296
IA
363A00000X
Physician Assistant
Primary
672
NE
363AM0700X
Medical Physician Assistant
672
NE
Other
Enumeration date
12/06/2007
Last updated
06/09/2025
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