Provider Demographics
NPI:1104200716
Name:CUSHINGBERRY, LATONIA YVETTE (FNP)
Entity Type:Individual
Prefix:
First Name:LATONIA
Middle Name:YVETTE
Last Name:CUSHINGBERRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 TWIN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5257
Mailing Address - Country:US
Mailing Address - Phone:513-628-0627
Mailing Address - Fax:
Practice Address - Street 1:154 TWIN LAKES DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5257
Practice Address - Country:US
Practice Address - Phone:513-628-0627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF07155500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily