Provider Demographics
NPI:1942191507
Name:PELLA, CLEMENT ADAM
Entity type:Individual
Prefix:
First Name:CLEMENT
Middle Name:ADAM
Last Name:PELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 W LUDWIG CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68528-2715
Mailing Address - Country:US
Mailing Address - Phone:402-327-8666
Mailing Address - Fax:
Practice Address - Street 1:4125 W LUDWIG CIR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68528-2715
Practice Address - Country:US
Practice Address - Phone:402-327-8666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider