Provider Demographics
NPI:1326447814
Name:TARBERT, JODINE
Entity Type:Individual
Prefix:
First Name:JODINE
Middle Name:
Last Name:TARBERT
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 1:2809 GREAT NORTHERN LOOP
Mailing Address - Street 2:200
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1749
Mailing Address - Country:US
Mailing Address - Phone:406-529-1789
Mailing Address - Fax:
Practice Address - Street 1:2809 GREAT NORTHERN LOOP
Practice Address - Street 2:#200
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1749
Practice Address - Country:US
Practice Address - Phone:406-529-1789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician