Individual provider Active NPI

Azibataram Benedicta Fatoye-Alagoa, LPN

  • Licensed Practical Nurse
  • Omaha, NE
National Provider Identifier
1801715941
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
22964 Issued in NE
Practice address
4101 Woolworth Ave
Omaha, NE 68105-1850
Phone
(402) 939-7838
Fax
(612) 725-1219
NPI assigned
Jul 13, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical NurseGroup: 193400000X SINGLE SPECIALTY GROUP 164W00000X 22964 NE Primary

Addresses

Primary practice location

4101 Woolworth Ave
Omaha, NE 68105-1850

Mailing address

6304 N 80TH St
Omaha, NE 68134-8100
Phone (402) 930-7838

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1783900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1801715941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6304 N 80TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681348100",
            "telephone_number": "402-930-7838",
            "fax_number": "612-725-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 WOOLWORTH AVE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681051850",
            "telephone_number": "402-939-7838",
            "fax_number": "612-725-1219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FATOYE-ALAGOA",
        "first_name": "AZIBATARAM",
        "middle_name": "BENEDICTA",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-07-13",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "NE",
            "license": "22964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.