Healthcare Provider Details

I. General information

NPI: 1568409001
Provider Name (Legal Business Name): DEAN ALLAN LIST NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8511 AUGUSTA DR
LINCOLN NE
68526-9572
US

IV. Provider business mailing address

8511 AUGUSTA DR
LINCOLN NE
68526-9572
US

V. Phone/Fax

Practice location:
  • Phone: 402-328-8833
  • Fax: 888-965-0959
Mailing address:
  • Phone: 402-328-2907
  • Fax: 888-965-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number110412
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: