Provider Demographics
NPI: | 1821006404 |
---|---|
Name: | NISSEN, ALAN J (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ALAN |
Middle Name: | J |
Last Name: | NISSEN |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 8055 O ST |
Mailing Address - Street 2: | STE 300 |
Mailing Address - City: | LINCOLN |
Mailing Address - State: | NE |
Mailing Address - Zip Code: | 68510-2580 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 402-421-0896 |
Mailing Address - Fax: | 402-421-0945 |
Practice Address - Street 1: | 575 S 70TH ST |
Practice Address - Street 2: | STE 440 |
Practice Address - City: | LINCOLN |
Practice Address - State: | NE |
Practice Address - Zip Code: | 68510-2471 |
Practice Address - Country: | US |
Practice Address - Phone: | 402-484-5500 |
Practice Address - Fax: | 402-484-5501 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-03 |
Last Update Date: | 2008-02-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NE | 14438 | 207Y00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NE | 100249918 00 | Medicaid | |
NE | 03276 | Other | BCBS |
10-00287 | Other | UHC | |
NE | 242496 | Other | MIDLAND'S CHOICE |
IA | 6446740 | Medicaid | |
NE | 10-00440 | Other | UHC |
NE | 03276 | Other | BCBS |
A51590 | Medicare UPIN | ||
NE | 10-00440 | Other | UHC |