Provider Demographics
NPI:1619864386
Name:TOULEASSI, HOLALI KODJOVI FOCADO
Entity type:Individual
Prefix:
First Name:HOLALI
Middle Name:KODJOVI FOCADO
Last Name:TOULEASSI
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 1:7804 KILPATRICK PKWY
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-3323
Mailing Address - Country:US
Mailing Address - Phone:402-591-9032
Mailing Address - Fax:
Practice Address - Street 1:7804 KILPATRICK PKWY
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-3323
Practice Address - Country:US
Practice Address - Phone:402-591-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider