Individual
LISA M SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7601 PIONEERS BLVD, LINCOLN, NE 68506-4675
(402) 484-6677
(402) 484-4476
Mailing address
7601 PIONEERS BLVD, LINCOLN, NE 68506-4675
(402) 484-6677
(402) 484-4476
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
20787
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
273355
AMI MEDICARE PIN
NE
05
—
47078180813
—
NE
01
—
NA1330008
SMI MEDICARE PIN
NE
Enumeration date
05/01/2006
Last updated
01/20/2017
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