Provider Demographics
NPI:1093154452
Name:CURTIS, LATASHA LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LATASHA
Middle Name:LYNN
Last Name:CURTIS
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 1:1445 GLACIER AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99505-1175
Mailing Address - Country:US
Mailing Address - Phone:859-473-4838
Mailing Address - Fax:
Practice Address - Street 1:1201 N MULDOON RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-6104
Practice Address - Country:US
Practice Address - Phone:907-257-6791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN082653164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse