Provider Demographics
NPI:1164259263
Name:TABOR, TIERRA (DOULA)
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:
Last Name:TABOR
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4574 BROADVIEW RD APT 1
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4680
Mailing Address - Country:US
Mailing Address - Phone:216-394-9511
Mailing Address - Fax:
Practice Address - Street 1:4574 BROADVIEW RD APT 1
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-4680
Practice Address - Country:US
Practice Address - Phone:216-394-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDOU.000017374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula