Provider Demographics
NPI:1649098781
Name:MAMER, AYOM
Entity type:Individual
Prefix:
First Name:AYOM
Middle Name:
Last Name:MAMER
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 1:2539 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-2249
Mailing Address - Country:US
Mailing Address - Phone:214-205-2409
Mailing Address - Fax:
Practice Address - Street 1:2539 N 18TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68110-2249
Practice Address - Country:US
Practice Address - Phone:214-205-2409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care