Provider Demographics
NPI:1821749748
Name:NGUSSE, EDEN EYOB
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:EYOB
Last Name:NGUSSE
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 1:6707 ENCHANTED COVE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6111
Mailing Address - Country:US
Mailing Address - Phone:702-428-5091
Mailing Address - Fax:
Practice Address - Street 1:12266 LORENZO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-6103
Practice Address - Country:US
Practice Address - Phone:028-996-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide