Healthcare Provider Details

I. General information

NPI: 1659288587
Provider Name (Legal Business Name): MAHAMOUDOU COMPAORE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19105 LAKE ST
ELKHORN NE
68022-7905
US

IV. Provider business mailing address

19105 LAKE ST
ELKHORN NE
68022-7905
US

V. Phone/Fax

Practice location:
  • Phone: 402-913-5156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: