Lisa Ann Blagdon

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

20758 Issued in NE

Practice address

4101 Woolworth Ave
Omaha, NE 68105-1850

Phone

(402) 930-7107

Fax

(402) 930-7103

NPI assigned

Oct 20, 2025

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1760918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760918400000",
    "number": "1770450223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10245 BERRY ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681273037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 WOOLWORTH AVE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681051850",
            "telephone_number": "402-930-7107",
            "fax_number": "402-930-7103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAGDON",
        "first_name": "LISA",
        "middle_name": "ANN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-10-20",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NE",
            "license": "20758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Viridian Blackwood
• Angela L Blad
• Jameson Blad
• Kenneth L Blad, M.D.
• Lisa A Bladt, MD
• Rachel Ann Blaine, BSW
• John Blaiotta
• Kristin Margaret Blair-Beals, PLDAC
• Heather Ann Blair, PA-C
• Jordan Blair

• Licensed Practical Nurse in Omaha, NE
• Providers in Omaha, NE by specialty
• Licensed Practical Nurse in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.