Provider Demographics
NPI:1740516905
Name:CHILDERS, TABITHA ERIN (LPN)
Entity type:Individual
Prefix:MISS
First Name:TABITHA
Middle Name:ERIN
Last Name:CHILDERS
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 1:3761 LACY CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-8106
Mailing Address - Country:US
Mailing Address - Phone:513-571-9236
Mailing Address - Fax:
Practice Address - Street 1:3761 LACY CT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-8106
Practice Address - Country:US
Practice Address - Phone:513-571-9236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.122813-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse