Provider Demographics
NPI:1053117606
Name:ADJINATA, ARMELLE TATIANA KINLETIN
Entity type:Individual
Prefix:
First Name:ARMELLE
Middle Name:TATIANA KINLETIN
Last Name:ADJINATA
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 1:12624 CAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-1923
Mailing Address - Country:US
Mailing Address - Phone:786-354-6084
Mailing Address - Fax:
Practice Address - Street 1:9001 ARBOR ST STE 206
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2066
Practice Address - Country:US
Practice Address - Phone:402-718-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant