Provider Demographics
NPI:1124833934
Name:PAW, THA S
Entity type:Individual
Prefix:
First Name:THA
Middle Name:S
Last Name:PAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 W C CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-1139
Mailing Address - Country:US
Mailing Address - Phone:531-829-0841
Mailing Address - Fax:
Practice Address - Street 1:2331 W C CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-1139
Practice Address - Country:US
Practice Address - Phone:531-829-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant