Healthcare Provider Details

I. General information

NPI: 1922806355
Provider Name (Legal Business Name): PELAGIE GWOUETZE YEYIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2610 W M CT
LINCOLN NE
68522-1006
US

IV. Provider business mailing address

4611 COOPER AVE APT 3
LINCOLN NE
68506-4230
US

V. Phone/Fax

Practice location:
  • Phone: 402-325-8555
  • Fax: 402-325-8575
Mailing address:
  • Phone: 402-890-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: