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General NPI Number Information
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NPI Number | 1467396366
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Entity Type | Individual
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Provider Name | SAMALISA EJIOGU
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Gender | Female
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 7200 S 84TH ST
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City | LA VISTA
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State | NE
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Zip | 68128-2115
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Country | US
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Telephone | 531-255-7764
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Fax | 531-255-7764
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Provider Business Mailing Address
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Address Line | 1702 RIDGEVIEW DR
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City | PAPILLION
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State | NE
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Zip | 68046-4268
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Country | US
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Telephone | 402-612-4404
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Fax | 402-612-4404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State | NE
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