Provider Demographics
NPI:1902526148
Name:COOK, LATIA PATRICIA
Entity Type:Individual
Prefix:
First Name:LATIA
Middle Name:PATRICIA
Last Name:COOK
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 1:1901 C ST SE APT 240
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2669
Mailing Address - Country:US
Mailing Address - Phone:240-273-0111
Mailing Address - Fax:
Practice Address - Street 1:3001 BLADENSBURG RD NE APT 919
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2238
Practice Address - Country:US
Practice Address - Phone:202-940-2447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC4668587374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide