Provider Demographics
NPI:1144690066
Name:PRAYER, LATISHA SHANNON (RN)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:SHANNON
Last Name:PRAYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8408 COTTONWOOD DR
Mailing Address - Street 2:APT. I
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-5917
Mailing Address - Country:US
Mailing Address - Phone:513-504-8059
Mailing Address - Fax:
Practice Address - Street 1:7900 WERNER AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3183
Practice Address - Country:US
Practice Address - Phone:513-742-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.389745163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse