Healthcare Provider Details

I. General information

NPI: 1316235351
Provider Name (Legal Business Name): SANDRA K TABOR ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 COLLEGE AVE # B100
MANHATTAN KS
66502-2770
US

IV. Provider business mailing address

1133 COLLEGE AVE # B100
MANHATTAN KS
66502-2770
US

V. Phone/Fax

Practice location:
  • Phone: 785-565-9500
  • Fax: 785-565-9595
Mailing address:
  • Phone: 785-565-9500
  • Fax: 785-565-9595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5375396
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: