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General NPI Number Information
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NPI Number | 1235949207
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Entity Type | Individual
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Provider Name | TABITHA NORTHRUP RN
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Gender | Female
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 4101 S 4TH ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-5014
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Country | US
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Telephone | 913-682-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 25434 183RD ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-8343
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Country | US
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Telephone | 307-575-2463
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 13164380111
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License Number State | KS
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