Provider Demographics
NPI:1770380479
Name:IBRAHIM, IBRAHIM JAMA
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:JAMA
Last Name:IBRAHIM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2903
Mailing Address - Country:US
Mailing Address - Phone:531-233-9771
Mailing Address - Fax:
Practice Address - Street 1:5022 S 114TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2329
Practice Address - Country:US
Practice Address - Phone:402-827-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist