Healthcare Provider Details

I. General information

NPI: 1710899562
Provider Name (Legal Business Name): ACHAN OUBANG AGIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9910 N 48TH ST STE 204
OMAHA NE
68152-1548
US

IV. Provider business mailing address

9910 N 48TH ST STE 204
OMAHA NE
68152-1548
US

V. Phone/Fax

Practice location:
  • Phone: 402-799-1799
  • Fax: 402-819-0949
Mailing address:
  • Phone: 402-799-1799
  • Fax: 402-819-0949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number169514
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: