Healthcare Provider Details

I. General information

NPI: 1063951077
Provider Name (Legal Business Name): DENA DOURISSEAU HAMPTON MS, RDN, LDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE
OMAHA NE
68105-1850
US

IV. Provider business mailing address

15125 GILDER AVE
BENNINGTON NE
68007-1567
US

V. Phone/Fax

Practice location:
  • Phone: 402-995-3511
  • Fax:
Mailing address:
  • Phone: 402-510-4829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1594
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1092560
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: