Healthcare Provider Details

I. General information

NPI: 1750285656
Provider Name (Legal Business Name): ALEXANDRA LAURELLE FETTIG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17725 WELCH PLZ STE D
OMAHA NE
68135-1404
US

IV. Provider business mailing address

17725 WELCH PLZ STE D
OMAHA NE
68135-1404
US

V. Phone/Fax

Practice location:
  • Phone: 402-624-4376
  • Fax:
Mailing address:
  • Phone: 402-624-4376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number117031
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: