Provider Demographics
NPI:1750960589
Name:TABOR, CHRISTINE (CM)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:TABOR
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 E 69TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-2831
Mailing Address - Country:US
Mailing Address - Phone:405-593-1719
Mailing Address - Fax:
Practice Address - Street 1:4444 E 41ST ST STE 2302
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2527
Practice Address - Country:US
Practice Address - Phone:918-660-3150
Practice Address - Fax:918-660-3143
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200980080AMedicaid