Provider Demographics
NPI:1760653208
Name:FALCON, TINA RABENBERG (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:RABENBERG
Last Name:FALCON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:ND
Mailing Address - Zip Code:58853-9998
Mailing Address - Country:US
Mailing Address - Phone:701-774-0461
Mailing Address - Fax:701-774-8003
Practice Address - Street 1:331 4TH AVE E
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:ND
Practice Address - Zip Code:58853-9998
Practice Address - Country:US
Practice Address - Phone:701-774-0461
Practice Address - Fax:701-774-8003
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL9583164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse