Provider Demographics
NPI:1083900500
Name:KING, LATASHA (LVN)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3359 EDISON AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2656
Mailing Address - Country:US
Mailing Address - Phone:916-397-1299
Mailing Address - Fax:
Practice Address - Street 1:3359 EDISON AVE APT 4
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2656
Practice Address - Country:US
Practice Address - Phone:916-397-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN-230615164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse