Provider Demographics
NPI:1578256160
Name:TABILI, MICHELLE SEPE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SEPE
Last Name:TABILI
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 1:759 TWICKENHAM LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-5991
Mailing Address - Country:US
Mailing Address - Phone:743-444-8932
Mailing Address - Fax:
Practice Address - Street 1:759 TWICKENHAM LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-5991
Practice Address - Country:US
Practice Address - Phone:743-444-8932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC327445163WM0705X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice