Individual
NDAIZEYE IMMACULEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4312 BURDETTE ST, OMAHA, NE 68111-3911
(402) 804-9568
Mailing address
4312 BURDETTE ST, OMAHA, NE 68111-3911
(402) 804-9568
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
H13603076
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H13603076
DRIVER'S LICENSE
NE
Enumeration date
11/16/2022
Last updated
11/16/2022
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