Provider Demographics
NPI:1578530614
Name:RANGEL, TABATHA A (PA)
Entity Type:Individual
Prefix:MRS
First Name:TABATHA
Middle Name:A
Last Name:RANGEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:N11896 W175
Mailing Address - Street 2:PO BOX 718
Mailing Address - City:LOMIRA
Mailing Address - State:WI
Mailing Address - Zip Code:53048
Mailing Address - Country:US
Mailing Address - Phone:414-566-6400
Mailing Address - Fax:414-566-3866
Practice Address - Street 1:N11896 W175
Practice Address - Street 2:
Practice Address - City:LOMIRA
Practice Address - State:WI
Practice Address - Zip Code:53048
Practice Address - Country:US
Practice Address - Phone:414-566-6400
Practice Address - Fax:414-566-3866
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1476-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant