Provider Demographics
NPI:1578369708
Name:SANOU, SOU AICHA AMANDINE
Entity type:Individual
Prefix:
First Name:SOU AICHA
Middle Name:AMANDINE
Last Name:SANOU
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 1:8102 S 90TH PLZ
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-4043
Mailing Address - Country:US
Mailing Address - Phone:501-410-6228
Mailing Address - Fax:
Practice Address - Street 1:401 SULLIVAN CIR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-5817
Practice Address - Country:US
Practice Address - Phone:501-410-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist