Provider Demographics
NPI:1154648491
Name:EVANS HASSELL, LATOSHA JEANNETTE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LATOSHA
Middle Name:JEANNETTE
Last Name:EVANS HASSELL
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 1:143 PARKDALE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-3416
Mailing Address - Country:US
Mailing Address - Phone:631-428-2981
Mailing Address - Fax:
Practice Address - Street 1:143 PARKDALE DR
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3416
Practice Address - Country:US
Practice Address - Phone:631-428-2981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300400164W00000X
NY796162163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse