Healthcare Provider Details

I. General information

NPI: 1336054576
Provider Name (Legal Business Name): JAHU MOISE DESSEMEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 S 87TH AVE
OMAHA NE
68124-3924
US

IV. Provider business mailing address

3712 S 87TH AVE
OMAHA NE
68124-3924
US

V. Phone/Fax

Practice location:
  • Phone: 531-233-9496
  • Fax:
Mailing address:
  • Phone: 531-233-9496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: