Provider Demographics
NPI:1669078432
Name:TABOR, DARIA
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:
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 1:1268 HOLLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1812
Mailing Address - Country:US
Mailing Address - Phone:513-206-5244
Mailing Address - Fax:
Practice Address - Street 1:1268 HOLLOWBROOK DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-1812
Practice Address - Country:US
Practice Address - Phone:513-206-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.174947164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse