Provider Demographics
NPI:1841612876
Name:FRASURE, TABATHA ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TABATHA
Middle Name:ANN
Last Name:FRASURE
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 1:2804 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-8810
Mailing Address - Country:US
Mailing Address - Phone:440-228-8202
Mailing Address - Fax:
Practice Address - Street 1:2804 BROWN RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-8810
Practice Address - Country:US
Practice Address - Phone:440-228-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.096796-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse