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Individual

RANDALL SCOTT LIENEMANN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHYSICIAN ASST PA C

Contact information

Practice address
987400 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-1799
(402) 559-6637
(402) 559-8333
Mailing address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
638
NE
363AM0700X
Medical Physician Assistant
638
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00165113
RR MCR
Enumeration date
05/30/2006
Last updated
04/16/2018
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