Provider Demographics
NPI:1972303378
Name:THONG, NYAREU BOL
Entity type:Individual
Prefix:
First Name:NYAREU
Middle Name:BOL
Last Name:THONG
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 1:5908 O AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-1529
Mailing Address - Country:US
Mailing Address - Phone:206-859-1551
Mailing Address - Fax:
Practice Address - Street 1:5908 O AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-1529
Practice Address - Country:US
Practice Address - Phone:206-859-1551
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant