Provider Demographics
NPI:1770175259
Name:WORLEY-TABOR, CHRISTINA LOUISA (OMD, CHT)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:LOUISA
Last Name:WORLEY-TABOR
Suffix:
Gender:F
Credentials:OMD, CHT
Other - Prefix:DR
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:TABOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OMD, CHT
Mailing Address - Street 1:2657 WINDMILL PKWY # 658
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-3384
Mailing Address - Country:US
Mailing Address - Phone:702-343-4905
Mailing Address - Fax:
Practice Address - Street 1:8610 S EASTERN AVE STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2836
Practice Address - Country:US
Practice Address - Phone:702-343-4905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2044171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20212006368OtherSTATE ISSUED