Provider Demographics
NPI:1740051705
Name:NELSON, TABITHA LYNN
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:LYNN
Last Name:NELSON
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 1:28 STABLETON WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-7501
Mailing Address - Country:US
Mailing Address - Phone:937-361-0789
Mailing Address - Fax:
Practice Address - Street 1:28 STABLETON WAY
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-7501
Practice Address - Country:US
Practice Address - Phone:937-361-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator