Provider Demographics
NPI:1801131883
Name:FRISON, LATOYA D
Entity type:Individual
Prefix:MS
First Name:LATOYA
Middle Name:D
Last Name:FRISON
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 1:1200 MARKET AVE APT 46B
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62201-2741
Mailing Address - Country:US
Mailing Address - Phone:618-960-8779
Mailing Address - Fax:
Practice Address - Street 1:1200 MARKET AVE APT 46B
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-2741
Practice Address - Country:US
Practice Address - Phone:618-960-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health