Provider Demographics
NPI:1598564437
Name:LAY, TAW THAN
Entity type:Individual
Prefix:
First Name:TAW
Middle Name:THAN
Last Name:LAY
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 1:3031 N 93RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-4715
Mailing Address - Country:US
Mailing Address - Phone:531-800-5326
Mailing Address - Fax:
Practice Address - Street 1:4233 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-1852
Practice Address - Country:US
Practice Address - Phone:651-398-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider