Provider Demographics
NPI:1336617612
Name:LABON, TAKASHI Y
Entity Type:Individual
Prefix:MRS
First Name:TAKASHI
Middle Name:Y
Last Name:LABON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-1237
Mailing Address - Country:US
Mailing Address - Phone:662-470-6867
Mailing Address - Fax:
Practice Address - Street 1:1652 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-1237
Practice Address - Country:US
Practice Address - Phone:662-470-6867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide