Provider Demographics
NPI:1902349848
Name:MATTHEW, LATWANA
Entity Type:Individual
Prefix:
First Name:LATWANA
Middle Name:
Last Name:MATTHEW
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 1:1640 BREAZEALE SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-4278
Mailing Address - Country:US
Mailing Address - Phone:318-352-9299
Mailing Address - Fax:
Practice Address - Street 1:1640 BREAZEALE SPRINGS ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-4278
Practice Address - Country:US
Practice Address - Phone:318-352-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-27
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134054363L00000X
LAAP09035363L00000X, 363LF0000X
LA09035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner