Provider Demographics
NPI:1346645207
Name:YOUNG, TABITHA MICHELLE VOSHELL (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:MICHELLE VOSHELL
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 RANSON ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2717
Mailing Address - Country:US
Mailing Address - Phone:816-787-7144
Mailing Address - Fax:
Practice Address - Street 1:1311 RANSON ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2717
Practice Address - Country:US
Practice Address - Phone:816-787-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOL-56392163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant