Basic Information
| Provider Information | |||||||||
| NPI: | 1891719571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PELICAN | ||||||||
| FirstName: | ALDIN | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 913041 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802913041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105945108 | ||||||||
| FaxNumber: | 6103631790 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ULYSSES | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678802133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203561266 | ||||||||
| FaxNumber: | 6204246313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 11/13/2018 | ||||||||
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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 | 367500000X | 1-081210 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 43-55702 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | CN0216 | 01 | AL | MEDICARE TRAVELERS | OTHER | P00380505 | 01 | AL | MEDICARE TRAVERLERS ID | OTHER | 015113326 | 05 | AL | MEDICAID | 105336 | 05 | AL | MEDICAID |