Provider Demographics
NPI:1003491416
Name:ANNAN, LATOSHA (RN)
Entity Type:Individual
Prefix:
First Name:LATOSHA
Middle Name:
Last Name:ANNAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WINTERBERRY DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-3533
Mailing Address - Country:US
Mailing Address - Phone:443-622-4578
Mailing Address - Fax:
Practice Address - Street 1:405 WINTERBERRY DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-3533
Practice Address - Country:US
Practice Address - Phone:443-622-4578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR161665163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse