Healthcare Provider Details

I. General information

NPI: 1558150904
Provider Name (Legal Business Name): NYEMACH GATTOUR KUON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S 17TH ST STE 726
OMAHA NE
68102-1901
US

IV. Provider business mailing address

2914 PATRICK AVE APT 162
OMAHA NE
68111-4191
US

V. Phone/Fax

Practice location:
  • Phone: 402-421-1119
  • Fax:
Mailing address:
  • Phone: 619-253-7209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: