Provider Demographics
NPI:1912867565
Name:PERISH, TABITHA
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:PERISH
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 1:213 20TH ST E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-2373
Mailing Address - Country:US
Mailing Address - Phone:701-729-0509
Mailing Address - Fax:
Practice Address - Street 1:213 20TH ST E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-2373
Practice Address - Country:US
Practice Address - Phone:701-729-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPER-96-8802347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle