Provider Demographics
NPI:1033650858
Name:GATES, LATASHA MICHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:MICHELLE
Last Name:GATES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 EASTMORELAND DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209
Mailing Address - Country:US
Mailing Address - Phone:614-306-8222
Mailing Address - Fax:
Practice Address - Street 1:2917 EASTMORELAND DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209
Practice Address - Country:US
Practice Address - Phone:614-306-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH115036164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse