Provider Demographics
NPI:1083373567
Name:KING, LATOYA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-3790
Mailing Address - Country:US
Mailing Address - Phone:630-243-3500
Mailing Address - Fax:
Practice Address - Street 1:1270 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-3790
Practice Address - Country:US
Practice Address - Phone:630-243-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041478835163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control