Provider Demographics
NPI:1518698919
Name:BADJAGLANA, BAKIR-WENA KOMLA
Entity Type:Individual
Prefix:MR
First Name:BAKIR-WENA
Middle Name:KOMLA
Last Name:BADJAGLANA
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 1:14822 GREBE ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-1219
Mailing Address - Country:US
Mailing Address - Phone:402-515-4044
Mailing Address - Fax:
Practice Address - Street 1:14822 GREBE ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-1219
Practice Address - Country:US
Practice Address - Phone:402-515-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114209363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care