Provider Demographics
NPI:1992504740
Name:ANTHONY, EDI KOFFI (RN)
Entity type:Individual
Prefix:MR
First Name:EDI
Middle Name:KOFFI
Last Name:ANTHONY
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6623 N 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-3018
Mailing Address - Country:US
Mailing Address - Phone:402-981-1920
Mailing Address - Fax:
Practice Address - Street 1:4205 S 96TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1259
Practice Address - Country:US
Practice Address - Phone:531-466-1275
Practice Address - Fax:531-242-4429
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE69402163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty