MEDICARE: MRS. NANTENIN NDIAYE SR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1508566084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANTENIN NDIAYE SR.

Provider Business Mailing Address
First Line	:	7207 S 141ST ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68138-6240
Country	:	US
Telephone Number	:	501-339-1434
Fax Number	:

Provider Business Practice Location Address
First Line	:	3710 FRANCES ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68105-3178
Country	:	US
Telephone Number	:	402-669-0092
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	03/03/2023

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