Provider Demographics
NPI:1386458263
Name:TCHOKPODO, LOAN FREDERICO
Entity type:Individual
Prefix:
First Name:LOAN
Middle Name:FREDERICO
Last Name:TCHOKPODO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9744 MOCKINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2013
Mailing Address - Country:US
Mailing Address - Phone:402-800-3787
Mailing Address - Fax:
Practice Address - Street 1:4831 N 109TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-2101
Practice Address - Country:US
Practice Address - Phone:402-800-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion