Individual
TEKILLA MARIE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7805 L ST, OMAHA, NE 68127-1855
(531) 375-1013
Mailing address
6713 BLONDO STREET APT 2, OMAHA, NE 68104
(531) 225-6667
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
H13598277
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H13598277
LICENSE
NE
Enumeration date
01/30/2025
Last updated
01/30/2025
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