Healthcare Provider Details

I. General information

NPI: 1902610694
Provider Name (Legal Business Name): NARCISSE N DJREKPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10809 CRAIG ST
OMAHA NE
68142-1193
US

IV. Provider business mailing address

204 GALVIN RD N
BELLEVUE NE
68005-4899
US

V. Phone/Fax

Practice location:
  • Phone: 402-973-4196
  • Fax:
Mailing address:
  • Phone: 402-769-9225
  • 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: