Provider Demographics
NPI:1841051745
Name:TABOR, ANGELA LACZELL
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LACZELL
Last Name:TABOR
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 1:7855 DEER SPRINGS WAY APT 1038
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-4007
Mailing Address - Country:US
Mailing Address - Phone:619-886-5091
Mailing Address - Fax:
Practice Address - Street 1:6741 N DECATUR BLVD BLDG 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2721
Practice Address - Country:US
Practice Address - Phone:702-462-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide