Provider Demographics
NPI:1316449663
Name:MCLEAN, ALYSHA A (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSHA
Middle Name:A
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSHA
Other - Middle Name:A
Other - Last Name:GARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1715 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-9501
Mailing Address - Country:US
Mailing Address - Phone:308-946-3015
Mailing Address - Fax:308-946-5914
Practice Address - Street 1:1715 26TH ST
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826
Practice Address - Country:US
Practice Address - Phone:308-946-3015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant