Provider Demographics
NPI:1952100760
Name:MOKTAN, SITA (CAREGIVER)
Entity type:Individual
Prefix:
First Name:SITA
Middle Name:
Last Name:MOKTAN
Suffix:
Gender:
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11305 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68142-1817
Mailing Address - Country:US
Mailing Address - Phone:402-305-7844
Mailing Address - Fax:
Practice Address - Street 1:11305 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68142-1817
Practice Address - Country:US
Practice Address - Phone:402-305-7844
Practice Address - Fax:
Is Sole Proprietor?:No
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
No372600000XNursing Service Related ProvidersAdult Companion