Provider Demographics
NPI:1043714314
Name:WACHIRA, TABITHA WANJIRU I (LVN)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:WANJIRU
Last Name:WACHIRA
Suffix:I
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12960 N COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:PONDER
Mailing Address - State:TX
Mailing Address - Zip Code:76259-5149
Mailing Address - Country:US
Mailing Address - Phone:254-760-5951
Mailing Address - Fax:
Practice Address - Street 1:12960 N COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:PONDER
Practice Address - State:TX
Practice Address - Zip Code:76259-5149
Practice Address - Country:US
Practice Address - Phone:254-760-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192490164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse