Provider Demographics
NPI:1669966644
Name:LISCH, AMANDA M (DO)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:M
Last Name:LISCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:SCHUMACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:10109 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-5554
Mailing Address - Country:US
Mailing Address - Phone:402-572-3500
Mailing Address - Fax:402-572-3505
Practice Address - Street 1:10109 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-5554
Practice Address - Country:US
Practice Address - Phone:402-572-3500
Practice Address - Fax:402-572-3505
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty