Provider Demographics
NPI:1235430539
Name:TABOR, LINDA SUE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUE
Last Name:TABOR
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 1:3574 PLYMOUTH SPRINGMILL RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-9527
Mailing Address - Country:US
Mailing Address - Phone:419-545-1016
Mailing Address - Fax:
Practice Address - Street 1:3574 PLYMOUTH SPRINGMILL RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-9527
Practice Address - Country:US
Practice Address - Phone:419-545-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 126026 M IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse