Provider Demographics
NPI:1205180601
Name:BAXTER, LATASHA C (LPN)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:C
Last Name:BAXTER
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 1:1714 MACOMBER ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-4455
Mailing Address - Country:US
Mailing Address - Phone:567-322-4939
Mailing Address - Fax:
Practice Address - Street 1:1714 MACOMBER ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-4455
Practice Address - Country:US
Practice Address - Phone:567-322-4939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147164164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH147164OtherOHIO BOARD OF NURSING