Basic Information
| Provider Information | |||||||||
| NPI: | 1821006404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NISSEN | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8055 O ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685102580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024210896 | ||||||||
| FaxNumber: | 4024210945 | ||||||||
| Practice Location | |||||||||
| Address1: | 575 S 70TH ST | ||||||||
| Address2: | STE 440 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685102471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024845500 | ||||||||
| FaxNumber: | 4024845501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 02/27/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 14438 | NE | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 100249918 00 | 05 | NE | MEDICAID | 03276 | 01 | NE | BCBS | OTHER | 10-00287 | 01 | UHC | OTHER | 242496 | 01 | NE | MIDLAND'S CHOICE | OTHER | 6446740 | 05 | IA | MEDICAID | 10-00440 | 01 | NE | UHC | OTHER |