Provider Demographics
NPI:1922997089
Name:TEVOEDJRE, ATEGBO JEROME
Entity type:Individual
Prefix:
First Name:ATEGBO
Middle Name:JEROME
Last Name:TEVOEDJRE
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 1:10235 WIESMAN DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1095
Mailing Address - Country:US
Mailing Address - Phone:402-742-0311
Mailing Address - Fax:402-614-0454
Practice Address - Street 1:10235 WIESMAN DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1095
Practice Address - Country:US
Practice Address - Phone:402-742-0311
Practice Address - Fax:402-614-0454
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant