Provider Demographics
NPI:1962208066
Name:YADULLAYEV, TOFIK
Entity type:Individual
Prefix:
First Name:TOFIK
Middle Name:
Last Name:YADULLAYEV
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 ELK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5152
Mailing Address - Country:US
Mailing Address - Phone:402-617-6796
Mailing Address - Fax:
Practice Address - Street 1:4508 ELK RIDGE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5152
Practice Address - Country:US
Practice Address - Phone:402-617-6796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant