Provider Demographics
NPI:1265071559
Name:GAGE, TABITHA LEIF (LPN)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:LEIF
Last Name:GAGE
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 1:6 GENESEE STREET
Mailing Address - Street 2:LEFT
Mailing Address - City:BELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:14813
Mailing Address - Country:US
Mailing Address - Phone:585-322-3984
Mailing Address - Fax:
Practice Address - Street 1:6 GENESEE STREET
Practice Address - Street 2:LEFT
Practice Address - City:BELMONT
Practice Address - State:NY
Practice Address - Zip Code:14813
Practice Address - Country:US
Practice Address - Phone:585-322-3984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261176164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse