Healthcare Provider Details

I. General information

NPI: 1285337667
Provider Name (Legal Business Name): ALYSE NELSEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 S MARYLAND PKWY
LAS VEGAS NV
89109-2306
US

IV. Provider business mailing address

4637 CHABOT DR STE 104
PLEASANTON CA
94588-2749
US

V. Phone/Fax

Practice location:
  • Phone: 702-961-5000
  • Fax:
Mailing address:
  • Phone: 865-500-1823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO4156
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: