Provider Demographics
NPI:1326819707
Name:ESSONO, GERTRUDE VANESSA
Entity Type:Individual
Prefix:
First Name:GERTRUDE VANESSA
Middle Name:
Last Name:ESSONO
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 1:14451 BOYD PLZ APT 205
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-6056
Mailing Address - Country:US
Mailing Address - Phone:531-329-9488
Mailing Address - Fax:
Practice Address - Street 1:14451 BOYD PLZ APT 205
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-6056
Practice Address - Country:US
Practice Address - Phone:531-329-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care