Provider Demographics
NPI:1497644876
Name:ABBA MOUSSA, BOUKAR
Entity type:Individual
Prefix:
First Name:BOUKAR
Middle Name:
Last Name:ABBA MOUSSA
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 1:3925 S 147TH ST STE 117
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5576
Mailing Address - Country:US
Mailing Address - Phone:531-225-5858
Mailing Address - Fax:
Practice Address - Street 1:3925 S 147TH ST STE 117
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5576
Practice Address - Country:US
Practice Address - Phone:531-225-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider