Provider Demographics
NPI:1225637937
Name:CHRISTIAN, LATISHA (STNA)
Entity Type:Individual
Prefix:MS
First Name:LATISHA
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 BELLOWS AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-1515
Mailing Address - Country:US
Mailing Address - Phone:380-222-1035
Mailing Address - Fax:
Practice Address - Street 1:957 BELLOWS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-1515
Practice Address - Country:US
Practice Address - Phone:380-222-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker