Provider Demographics
NPI:1407675267
Name:TABORN, DEVON LIANNE
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:LIANNE
Last Name:TABORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4919 ETNA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2437
Mailing Address - Country:US
Mailing Address - Phone:937-606-0275
Mailing Address - Fax:
Practice Address - Street 1:4919 ETNA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2437
Practice Address - Country:US
Practice Address - Phone:937-606-0275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide