Provider Demographics
NPI:1831468883
Name:TABOR, MAEGEN (RN)
Entity Type:Individual
Prefix:
First Name:MAEGEN
Middle Name:
Last Name:TABOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11358 REDWOOD PL
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-7768
Mailing Address - Country:US
Mailing Address - Phone:651-271-0453
Mailing Address - Fax:
Practice Address - Street 1:11358 REDWOOD PL
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-7768
Practice Address - Country:US
Practice Address - Phone:651-271-0453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 161562-7163W00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163W00000XNursing Service ProvidersRegistered Nurse