Provider Demographics
NPI:1962202457
Name:THAW, EH LOR MUH THAW
Entity type:Individual
Prefix:
First Name:EH LOR MUH
Middle Name:THAW
Last Name:THAW
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 1:11915 BAUMAN AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-6847
Mailing Address - Country:US
Mailing Address - Phone:402-312-1475
Mailing Address - Fax:
Practice Address - Street 1:13314 KINGSWOOD DR APT 4
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3447
Practice Address - Country:US
Practice Address - Phone:402-312-1475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider