Provider Demographics
NPI:1033918032
Name:MOO, EH THA YOU
Entity type:Individual
Prefix:
First Name:EH
Middle Name:THA YOU
Last Name:MOO
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 1:6125 FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-2098
Mailing Address - Country:US
Mailing Address - Phone:402-812-9929
Mailing Address - Fax:
Practice Address - Street 1:5417 CAMDEN AVE # NE68104
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-1716
Practice Address - Country:US
Practice Address - Phone:402-812-9929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant