Provider Demographics
NPI:1003607524
Name:TET, RA
Entity type:Individual
Prefix:
First Name:RA
Middle Name:
Last Name:TET
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 1:4819 N 66TH ST APT 133
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-1938
Mailing Address - Country:US
Mailing Address - Phone:518-229-9231
Mailing Address - Fax:
Practice Address - Street 1:4819 N 66TH ST APT 133
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-1938
Practice Address - Country:US
Practice Address - Phone:518-229-9231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health