Provider Demographics
NPI:1124357827
Name:LATHAM, ANITRA (STNA)
Entity Type:Individual
Prefix:
First Name:ANITRA
Middle Name:
Last Name:LATHAM
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4724 GLENWAY AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-4587
Mailing Address - Country:US
Mailing Address - Phone:513-244-7581
Mailing Address - Fax:
Practice Address - Street 1:4724 GLENWAY AVE APT 109
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-4587
Practice Address - Country:US
Practice Address - Phone:513-244-7581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide