Provider Demographics
NPI:1316406754
Name:SHOULDERS, LATONYA R
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:R
Last Name:SHOULDERS
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 1:5361 MALLARD CIR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-5626
Mailing Address - Country:US
Mailing Address - Phone:216-536-2991
Mailing Address - Fax:
Practice Address - Street 1:5361 MALLARD CIR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-5626
Practice Address - Country:US
Practice Address - Phone:216-536-2991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024294363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner