Provider Demographics
NPI:1285208512
Name:CHRISTIAN, LATOYA YVONNE (RN)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:YVONNE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11943 SUMMERHAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-7534
Mailing Address - Country:US
Mailing Address - Phone:228-424-5490
Mailing Address - Fax:
Practice Address - Street 1:11943 SUMMERHAVEN CIR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-7534
Practice Address - Country:US
Practice Address - Phone:228-424-5490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS913023163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse