Provider Demographics
NPI:1861299869
Name:MAIDUTE, NYAKWEW JAMES
Entity type:Individual
Prefix:
First Name:NYAKWEW
Middle Name:JAMES
Last Name:MAIDUTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-2913
Mailing Address - Country:US
Mailing Address - Phone:531-721-5086
Mailing Address - Fax:
Practice Address - Street 1:4721 S 19TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-2913
Practice Address - Country:US
Practice Address - Phone:531-721-5086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1282773747P1801X
NE897463747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant