Provider Demographics
NPI:1346019353
Name:SPANIER, LATISHA MARY
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:MARY
Last Name:SPANIER
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 1:675 HAMPTON DR E
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6779
Mailing Address - Country:US
Mailing Address - Phone:701-371-5661
Mailing Address - Fax:
Practice Address - Street 1:675 HAMPTON DR E
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-6779
Practice Address - Country:US
Practice Address - Phone:701-371-5661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide