Healthcare Provider Details

I. General information

NPI: 1649045345
Provider Name (Legal Business Name): ALYSON IDA PELAN AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 LAKERIDGE DR STE 104A
NORFOLK NE
68701-2558
US

IV. Provider business mailing address

2501 LAKERIDGE DR STE 104A
NORFOLK NE
68701-2558
US

V. Phone/Fax

Practice location:
  • Phone: 402-204-0651
  • Fax:
Mailing address:
  • Phone: 402-204-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number115107
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: