Provider Demographics
NPI:1083394761
Name:LATTIMORE, ANANSA JEANINE (CD(DONA))
Entity Type:Individual
Prefix:
First Name:ANANSA
Middle Name:JEANINE
Last Name:LATTIMORE
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 W BANK ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-4001
Mailing Address - Country:US
Mailing Address - Phone:818-858-5100
Mailing Address - Fax:
Practice Address - Street 1:911 W BANK ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4001
Practice Address - Country:US
Practice Address - Phone:818-858-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15038374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula