Provider Demographics
NPI:1205014131
Name:LANSING, TABITHA LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:LYNN
Last Name:LANSING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 FLANDERS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-1336
Mailing Address - Country:US
Mailing Address - Phone:937-770-1144
Mailing Address - Fax:
Practice Address - Street 1:307 FLANDERS AVE
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-1336
Practice Address - Country:US
Practice Address - Phone:937-770-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN113445164W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse