Healthcare Provider Details

I. General information

NPI: 1841617339
Provider Name (Legal Business Name): ALYSSA MAXWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 S 11TH ST
LINCOLN NE
68502-3559
US

IV. Provider business mailing address

2633 P ST
LINCOLN NE
68503-3528
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-5161
  • Fax:
Mailing address:
  • Phone: 402-475-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5280
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: