Provider Demographics
NPI:1902502412
Name:PUGH, LATOSHA (CNA)
Entity Type:Individual
Prefix:
First Name:LATOSHA
Middle Name:
Last Name:PUGH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WOODIE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:AL
Mailing Address - Zip Code:36545-2012
Mailing Address - Country:US
Mailing Address - Phone:251-525-1903
Mailing Address - Fax:
Practice Address - Street 1:111 WOODIE AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:AL
Practice Address - Zip Code:36545-2012
Practice Address - Country:US
Practice Address - Phone:251-525-1903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL$$$$$$$$$374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide