Provider Demographics
NPI:1477385664
Name:TABADA, CHADWICK FLINT LEE (BSN, RN)
Entity type:Individual
Prefix:MR
First Name:CHADWICK FLINT
Middle Name:LEE
Last Name:TABADA
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4065 KNOBBY CREST WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4543
Mailing Address - Country:US
Mailing Address - Phone:510-282-7076
Mailing Address - Fax:
Practice Address - Street 1:4065 KNOBBY CREST WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-4543
Practice Address - Country:US
Practice Address - Phone:510-282-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60363350163W00000X
CA95387982163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse