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General NPI Number Information
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NPI Number | 1750057774
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Entity Type | Individual
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Provider Name | ALISSA CAROLINE EVANS
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Gender | Female
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 10/29/2021
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Provider Practice Location Address
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Address Line | 2700 W NORFOLK AVE
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City | NORFOLK
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State | NE
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Zip | 68701-4438
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Country | US
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Telephone | 402-371-4880
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Fax |
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Provider Business Mailing Address
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Address Line | 802 E 3RD ST
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City | NELIGH
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State | NE
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Zip | 68756-1500
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Country | US
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Telephone | 402-992-7168
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 55923
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 113885
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License Number State | NE
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