Healthcare Provider Details

I. General information

NPI: 1679370126
Provider Name (Legal Business Name): SEYDOU OUATTARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 SUMMIT PLAZA DR
BELLEVUE NE
68123-1065
US

IV. Provider business mailing address

7708 S 184TH AVE
OMAHA NE
68136-6557
US

V. Phone/Fax

Practice location:
  • Phone: 402-444-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: