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General NPI Number Information
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NPI Number | 1750177366
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Entity Type | Individual
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Provider Name | LAKESHA D TABRON
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Gender | Female
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 3955 W WASHINGTON CENTER RD
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City | FORT WAYNE
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State | IN
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Zip | 46818-1526
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Country | US
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Telephone | 317-762-8212
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Fax |
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Provider Business Mailing Address
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Address Line | 3955 W WASHINGTON CENTER RD
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City | FORT WAYNE
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State | IN
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Zip | 46818-1526
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Country | US
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Telephone | 317-762-8212
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 28224955A
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License Number State | IN
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