Provider Demographics
NPI:1679399588
Name:RAMOS FERNANDEZ, LILIAN ROXANA
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:ROXANA
Last Name:RAMOS FERNANDEZ
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 1:4215 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-2018
Mailing Address - Country:US
Mailing Address - Phone:531-299-2100
Mailing Address - Fax:
Practice Address - Street 1:4215 S 20TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-2018
Practice Address - Country:US
Practice Address - Phone:531-299-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant