Provider Demographics
NPI:1447909148
Name:KABORE, SIMON
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:KABORE
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 1:3509 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68147-1252
Mailing Address - Country:US
Mailing Address - Phone:646-546-2957
Mailing Address - Fax:
Practice Address - Street 1:2633 N 165TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-7506
Practice Address - Country:US
Practice Address - Phone:646-546-2957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist