Provider Demographics
NPI:1730077660
Name:SOE, TIN
Entity type:Individual
Prefix:
First Name:TIN
Middle Name:
Last Name:SOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 N 93RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-4715
Mailing Address - Country:US
Mailing Address - Phone:531-800-5326
Mailing Address - Fax:
Practice Address - Street 1:4517 N 37TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-2243
Practice Address - Country:US
Practice Address - Phone:412-863-8404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider