Individual
MR. CHARLES DEAN TABBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6822 PROVIDENCE ST STE 2633, WHITEHOUSE, OH 43571-9530
(419) 708-8175
Mailing address
6822 PROVIDENCE ST STE 2633, WHITEHOUSE, OH 43571-9530
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN.CRNA.18591
OH
367500000X
Certified Registered Nurse Anesthetist
COA.18591-NA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0155072
—
OH
Enumeration date
01/14/2016
Last updated
11/23/2020
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