Healthcare Provider Details

I. General information

NPI: 1134950041
Provider Name (Legal Business Name): ALOUGBA GNONSE-PADONOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2661 DOUGLAS ST
OMAHA NE
68131-2626
US

IV. Provider business mailing address

7929 W CENTER RD
OMAHA NE
68124-3104
US

V. Phone/Fax

Practice location:
  • Phone: 402-455-9760
  • Fax:
Mailing address:
  • Phone: 402-978-5632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number115475
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: