Individual
SOUDAPHONE VISONNAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8101 S 194TH ST, GRETNA, NE 68028-6438
(682) 540-1817
Mailing address
8101 S 194TH ST, GRETNA, NE 68028-6438
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
10/30/2025
Last updated
10/30/2025
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