Provider Demographics
NPI:1073100129
Name:EMMENS, OMAR (LPN)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:EMMENS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 BULLENS LN
Mailing Address - Street 2:
Mailing Address - City:WOODLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19094-1902
Mailing Address - Country:US
Mailing Address - Phone:484-649-4581
Mailing Address - Fax:
Practice Address - Street 1:146 BULLENS LN
Practice Address - Street 2:
Practice Address - City:WOODLYN
Practice Address - State:PA
Practice Address - Zip Code:19094-1902
Practice Address - Country:US
Practice Address - Phone:484-649-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN281094164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse