Provider Demographics
NPI:1275100687
Name:LATTIMORE, ALEXZANDRIA
Entity Type:Individual
Prefix:
First Name:ALEXZANDRIA
Middle Name:
Last Name:LATTIMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 MEREDITH DR UNIT 21
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-3246
Mailing Address - Country:US
Mailing Address - Phone:513-290-2310
Mailing Address - Fax:
Practice Address - Street 1:1549 MEREDITH DR UNIT 21
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3246
Practice Address - Country:US
Practice Address - Phone:513-290-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH.Medicaid