Provider Demographics
NPI:1154819563
Name:SMITH, LATOSHA LYNISHA (RN, BSN,PHN)
Entity Type:Individual
Prefix:
First Name:LATOSHA
Middle Name:LYNISHA
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, BSN,PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 DYSART RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4406
Mailing Address - Country:US
Mailing Address - Phone:661-916-0470
Mailing Address - Fax:
Practice Address - Street 1:5241 WILSON MILLS RD STE 31A
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2142
Practice Address - Country:US
Practice Address - Phone:661-916-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168110164W00000X
OH487060163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA