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General NPI Number Information
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NPI Number | 1336091412
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Entity Type | Individual
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Provider Name | ALEXIS VANDEWALLE
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Gender | Female
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 111 PUBLIC SAFETY DR
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City | GRAND ISLAND
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State | NE
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Zip | 68801-8510
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Country | US
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Telephone | 308-223-0679
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3
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City | CEDAR RAPIDS
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State | NE
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Zip | 68627-0003
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | CPSS-335
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License Number State | NE
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