Provider Demographics
NPI:1679370696
Name:KOUASSI, ESTELLE ADJOAVI
Entity type:Individual
Prefix:
First Name:ESTELLE
Middle Name:ADJOAVI
Last Name:KOUASSI
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 1:8125 S 87TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-2474
Mailing Address - Country:US
Mailing Address - Phone:310-598-8236
Mailing Address - Fax:
Practice Address - Street 1:4712 N 107TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-2410
Practice Address - Country:US
Practice Address - Phone:310-598-8236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant