Provider Demographics
NPI:1053299875
Name:PWEA, DECEMBER PAW
Entity type:Individual
Prefix:
First Name:DECEMBER
Middle Name:PAW
Last Name:PWEA
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 1:4911 N 64TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-1908
Mailing Address - Country:US
Mailing Address - Phone:402-609-6645
Mailing Address - Fax:
Practice Address - Street 1:1913 SW 11TH ST LOT 199
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-1666
Practice Address - Country:US
Practice Address - Phone:801-759-7175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant