Provider Demographics
NPI:1952015984
Name:IRVING, KARAH TEON
Entity Type:Individual
Prefix:
First Name:KARAH
Middle Name:TEON
Last Name:IRVING
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 1:4812 FONTENELLE BLVD # A
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-2162
Mailing Address - Country:US
Mailing Address - Phone:402-618-4535
Mailing Address - Fax:
Practice Address - Street 1:4812 FONTENELLE BLVD # A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-2162
Practice Address - Country:US
Practice Address - Phone:402-618-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE921692276374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty