Provider Demographics
NPI:1124827969
Name:SANDAOGO, MARIAM
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:SANDAOGO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MARIAM
Other - Middle Name:
Other - Last Name:OUEDRAOGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11672 BURT ST APT M1
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1527
Mailing Address - Country:US
Mailing Address - Phone:402-403-7822
Mailing Address - Fax:
Practice Address - Street 1:11672 BURT ST APT M1
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1527
Practice Address - Country:US
Practice Address - Phone:402-504-2641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion