Provider Demographics
NPI:1710620794
Name:OMEUS, ESTEVANCIA
Entity Type:Individual
Prefix:
First Name:ESTEVANCIA
Middle Name:
Last Name:OMEUS
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 1:301 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836
Mailing Address - Country:US
Mailing Address - Phone:239-234-7614
Mailing Address - Fax:
Practice Address - Street 1:301 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836
Practice Address - Country:US
Practice Address - Phone:239-234-7614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant