Provider Demographics
NPI:1093083743
Name:TABOH, LAUREN ELISSA (NP, RN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELISSA
Last Name:TABOH
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Gender:F
Credentials:NP, RN
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Mailing Address - Street 1:27901 WOODWARD AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-0919
Mailing Address - Country:US
Mailing Address - Phone:248-556-5582
Mailing Address - Fax:248-850-7142
Practice Address - Street 1:27901 WOODWARD AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0919
Practice Address - Country:US
Practice Address - Phone:248-556-5582
Practice Address - Fax:248-850-7142
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2015-03-23
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Provider Licenses
StateLicense IDTaxonomies
MI4704259700163W00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse