Provider Demographics
NPI:1134091960
Name:FAGBOHOUN, LANDRY
Entity type:Individual
Prefix:
First Name:LANDRY
Middle Name:
Last Name:FAGBOHOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 N HILL RD APT 208
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-4734
Mailing Address - Country:US
Mailing Address - Phone:402-432-6259
Mailing Address - Fax:
Practice Address - Street 1:3133 N HILL RD APT 208
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-4734
Practice Address - Country:US
Practice Address - Phone:402-432-6259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant