Provider Demographics
NPI:1669197711
Name:AIREN, DYAN EVBIOMWAN
Entity type:Individual
Prefix:
First Name:DYAN
Middle Name:EVBIOMWAN
Last Name:AIREN
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 1:5038 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3111
Mailing Address - Country:US
Mailing Address - Phone:713-851-3614
Mailing Address - Fax:
Practice Address - Street 1:5038 CENTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3111
Practice Address - Country:US
Practice Address - Phone:713-851-3614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist