Provider Demographics
NPI:1699580522
Name:BASSONO, CHRISTOPHE B
Entity type:Individual
Prefix:
First Name:CHRISTOPHE
Middle Name:B
Last Name:BASSONO
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 1:7714 S 191ST ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1662
Mailing Address - Country:US
Mailing Address - Phone:402-658-5059
Mailing Address - Fax:
Practice Address - Street 1:7714 S 191ST ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-1662
Practice Address - Country:US
Practice Address - Phone:402-658-5059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100682372600000X
372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion