Provider Demographics
NPI:1891719571
Name:PELICAN, ALDIN JOHN (CRNA)
Entity type:Individual
Prefix:MR
First Name:ALDIN
Middle Name:JOHN
Last Name:PELICAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 913041
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-3041
Mailing Address - Country:US
Mailing Address - Phone:610-594-5108
Mailing Address - Fax:610-363-1790
Practice Address - Street 1:415 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2133
Practice Address - Country:US
Practice Address - Phone:620-356-1266
Practice Address - Fax:620-424-6313
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-081210367500000X
KS43-55702367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCN0216OtherMEDICARE TRAVELERS
ALP00380505OtherMEDICARE TRAVERLERS ID
AL015113326Medicaid
AL105336Medicaid
ALS35933Medicare UPIN
AL051513326Medicare PIN