Healthcare Provider Details

I. General information

NPI: 1467378687
Provider Name (Legal Business Name): ELOM TEDJI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14915 ECHO HILLS DR
OMAHA NE
68138-6459
US

IV. Provider business mailing address

9744 MOCKINGBIRD DR
OMAHA NE
68127-2013
US

V. Phone/Fax

Practice location:
  • Phone: 402-516-6777
  • Fax:
Mailing address:
  • Phone: 402-800-3787
  • 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: