Provider Demographics
NPI:1497965248
Name:TABOR, ALLYSON MARIA (RN, PHN)
Entity Type:Individual
Prefix:MS
First Name:ALLYSON
Middle Name:MARIA
Last Name:TABOR
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 CLEMENT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6329
Mailing Address - Country:US
Mailing Address - Phone:530-544-6636
Mailing Address - Fax:
Practice Address - Street 1:1360 JOHNSON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8201
Practice Address - Country:US
Practice Address - Phone:530-573-3027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA517796364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health