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NPI Code Detail

MEDICARE: LISA KATHERINE TABOR APRN, ACNP-BC

MEDICARE:   LISA KATHERINE TABOR  APRN, ACNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse PractitionerAPRN002065NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285631044
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA KATHERINE TABOR APRN, ACNP-BC
Provider Business Mailing Address
First Line : 9900 BREN ROAD EAST
Second Line : MAIL ROUTE MN 008-8213
City : MINNETONKA
State : MN
Zip : 55343
Country : US
Telephone Number : 337-804-2049
Fax Number :
Provider Business Practice Location Address
First Line : 6545 S FORT APACHE RD STE 135-228
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-6752
Country : US
Telephone Number : 337-804-2049
Fax Number : 877-866-3181
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 06/30/2020

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Directions to “ LISA KATHERINE TABOR APRN, ACNP-BC” Practice Location

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