Provider Demographics
NPI:1700572393
Name:ATTIOGBE-AGBEMADON, DEDE C (APRN-NP)
Entity Type:Individual
Prefix:
First Name:DEDE
Middle Name:C
Last Name:ATTIOGBE-AGBEMADON
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:MRS
Other - First Name:DEDE
Other - Middle Name:C
Other - Last Name:ATTIOGBE-AGBEMADON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-NP
Mailing Address - Street 1:7445 N 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-5259
Mailing Address - Country:US
Mailing Address - Phone:402-686-1020
Mailing Address - Fax:
Practice Address - Street 1:7445 N 89TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-5259
Practice Address - Country:US
Practice Address - Phone:402-686-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily