Provider Demographics
NPI:1861299174
Name:OUEDRAOGO, ALASSANE
Entity type:Individual
Prefix:
First Name:ALASSANE
Middle Name:
Last Name:OUEDRAOGO
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 1:5854 S 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-3034
Mailing Address - Country:US
Mailing Address - Phone:718-450-5452
Mailing Address - Fax:
Practice Address - Street 1:9001 ARBOR ST STE 206
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2066
Practice Address - Country:US
Practice Address - Phone:402-718-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant