Provider Demographics
NPI:1861171217
Name:FIELDS, LATOYA LOUISE
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:LOUISE
Last Name:FIELDS
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:PO BOX 22143
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-0143
Mailing Address - Country:US
Mailing Address - Phone:330-701-5322
Mailing Address - Fax:
Practice Address - Street 1:161 PORTAGE DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1112
Practice Address - Country:US
Practice Address - Phone:330-701-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRSO98902172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver