Provider Demographics
NPI:1770452922
Name:WAGNER, ALYSSA ROCHELLE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ROCHELLE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:ROCHELLE
Other - Last Name:RAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3119 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68112-1726
Mailing Address - Country:US
Mailing Address - Phone:712-899-9474
Mailing Address - Fax:
Practice Address - Street 1:105 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-5220
Practice Address - Country:US
Practice Address - Phone:402-933-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion