Provider Demographics
NPI:1255130167
Name:MU, TA
Entity type:Individual
Prefix:
First Name:TA
Middle Name:
Last Name:MU
Suffix:
Gender:
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 1:15505 KING CIR
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-1818
Practice Address - Country:US
Practice Address - Phone:385-216-9877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider