Provider Demographics
NPI:1194454025
Name:DICKERSON-TEDDER, LATANYA D (DOULA)
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:D
Last Name:DICKERSON-TEDDER
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 FOUR MILE RUN PKWY
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-8902
Mailing Address - Country:US
Mailing Address - Phone:804-683-8689
Mailing Address - Fax:
Practice Address - Street 1:7801 FOUR MILE RUN PKWY
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-8902
Practice Address - Country:US
Practice Address - Phone:804-683-8689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula