Provider Demographics
NPI:1578451159
Name:ABDALLA, ABU ELGASIM
Entity type:Individual
Prefix:
First Name:ABU ELGASIM
Middle Name:
Last Name:ABDALLA
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 1:1503 N 48TH ST APT 12
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-5152
Mailing Address - Country:US
Mailing Address - Phone:402-578-1802
Mailing Address - Fax:
Practice Address - Street 1:1309 N 49TH ST APT 143
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-1641
Practice Address - Country:US
Practice Address - Phone:402-850-8096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide