Provider Demographics
NPI:1881035822
Name:TABOT, SEBASTIAN EGBE (LPN)
Entity Type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:EGBE
Last Name:TABOT
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 BROOKEVILLE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1269
Mailing Address - Country:US
Mailing Address - Phone:614-622-3092
Mailing Address - Fax:
Practice Address - Street 1:1449 BROOKEVILLE CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1269
Practice Address - Country:US
Practice Address - Phone:614-622-3092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-06
Last Update Date:2013-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152469164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse