Provider Demographics
NPI:1346861259
Name:ALFRED, LARESHIA ANNETTE
Entity Type:Individual
Prefix:
First Name:LARESHIA
Middle Name:ANNETTE
Last Name:ALFRED
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 1:1717 MARTINIQUE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8547
Mailing Address - Country:US
Mailing Address - Phone:469-558-5097
Mailing Address - Fax:
Practice Address - Street 1:1717 MARTINIQUE DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8547
Practice Address - Country:US
Practice Address - Phone:469-558-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty