Provider Demographics
NPI:1063741072
Name:SUBER, TANISHA LA'SHAY (LPN)
Entity type:Individual
Prefix:MISS
First Name:TANISHA
Middle Name:LA'SHAY
Last Name:SUBER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 CHESTNUT CROSSING DR APT H
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-3622
Mailing Address - Country:US
Mailing Address - Phone:215-910-8361
Mailing Address - Fax:
Practice Address - Street 1:143 CHESTNUT CROSSING DR APT H
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-3622
Practice Address - Country:US
Practice Address - Phone:215-910-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0010742164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse