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General NPI Number Information
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NPI Number | 1497965248
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Entity Type | Individual
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Provider Name | ALLYSON MARIA TABOR R.N., P.H.N.
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1360 JOHNSON BLVD STE 103
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-8201
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Country | US
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Telephone | 530-573-3027
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Fax |
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Provider Business Mailing Address
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Address Line | 843 CLEMENT ST
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-6329
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Country | US
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Telephone | 530-544-6636
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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 | 364SC1501X
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Taxonomy Name | Community Health/Public Health Clinical Nurse Specialist
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License Number | 517796
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License Number State | CA
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