Provider Demographics
NPI:1679372239
Name:AMEFIA-KOFFIE, KOFFI ELI FOGAN (DSP)
Entity type:Individual
Prefix:
First Name:KOFFI
Middle Name:ELI FOGAN
Last Name:AMEFIA-KOFFIE
Suffix:
Gender:
Credentials:DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 N 107TH ST # NE68134
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-3664
Mailing Address - Country:US
Mailing Address - Phone:402-502-1035
Mailing Address - Fax:
Practice Address - Street 1:3317 N 107TH ST # NE68134
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-3664
Practice Address - Country:US
Practice Address - Phone:402-502-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker