Provider Demographics
NPI:1164185773
Name:KINGSBY, LATRINA (RN)
Entity Type:Individual
Prefix:
First Name:LATRINA
Middle Name:
Last Name:KINGSBY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LATRINA
Other - Middle Name:
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:7034 N 55TH ST APT C
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-6336
Mailing Address - Country:US
Mailing Address - Phone:414-405-9002
Mailing Address - Fax:
Practice Address - Street 1:4911 W GOOD HOPE RD UNIT D
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-4840
Practice Address - Country:US
Practice Address - Phone:414-405-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI168145163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty