Provider Demographics
NPI:1497546683
Name:AGOLMIASSOU, MASSAMESSO DAVID
Entity type:Individual
Prefix:
First Name:MASSAMESSO
Middle Name:DAVID
Last Name:AGOLMIASSOU
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 1:2121 N 120TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3477
Mailing Address - Country:US
Mailing Address - Phone:402-840-7168
Mailing Address - Fax:
Practice Address - Street 1:2121 N 120TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3477
Practice Address - Country:US
Practice Address - Phone:402-840-7168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion