Provider Demographics
NPI:1902265515
Name:DAVIS, LATARSHA ELENA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:LATARSHA
Middle Name:ELENA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 7TH AVE
Mailing Address - Street 2:APT 3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3612
Mailing Address - Country:US
Mailing Address - Phone:646-321-0124
Mailing Address - Fax:
Practice Address - Street 1:1827 7TH AVE
Practice Address - Street 2:APT 3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3612
Practice Address - Country:US
Practice Address - Phone:646-321-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270590-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse