Individual
EH LAR1 PAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4008 N 63RD ST, OMAHA, NE 68104-2637
(402) 506-4112
Mailing address
4008 N 63RD ST, OMAHA, NE 68104-2637
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
12/22/2025
Last updated
12/22/2025
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