Provider Demographics
NPI:1750177366
Name:TABRON, LAKESHA D
Entity type:Individual
Prefix:
First Name:LAKESHA
Middle Name:D
Last Name:TABRON
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 1:3955 W WASHINGTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-1526
Mailing Address - Country:US
Mailing Address - Phone:317-762-8212
Mailing Address - Fax:
Practice Address - Street 1:3955 W WASHINGTON CENTER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-1526
Practice Address - Country:US
Practice Address - Phone:317-762-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28224955A163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management