Provider Demographics
NPI:1023819463
Name:MOO, DESENA
Entity type:Individual
Prefix:
First Name:DESENA
Middle Name:
Last Name:MOO
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 1:7968 N 152ND ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-1583
Mailing Address - Country:US
Mailing Address - Phone:402-216-9347
Mailing Address - Fax:
Practice Address - Street 1:7968 N 152ND ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-1583
Practice Address - Country:US
Practice Address - Phone:402-216-9347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide