Provider Demographics
NPI:1679573653
Name:NOLLENDORFS, ALISA JOANN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:JOANN
Last Name:NOLLENDORFS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3402 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4600 VALLEY RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4855
Practice Address - Country:US
Practice Address - Phone:402-483-4571
Practice Address - Fax:402-475-6003
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47082189713Medicaid
NE47082189713Medicaid
NE277468Medicare ID - Type Unspecified