Provider Demographics
NPI:1376305482
Name:HARE, LATARSHE
Entity Type:Individual
Prefix:
First Name:LATARSHE
Middle Name:
Last Name:HARE
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 1:11159 STEINER STORE RD
Mailing Address - Street 2:
Mailing Address - City:FORT DEPOSIT
Mailing Address - State:AL
Mailing Address - Zip Code:36032-4326
Mailing Address - Country:US
Mailing Address - Phone:334-392-9389
Mailing Address - Fax:
Practice Address - Street 1:11159 STEINER STORE RD
Practice Address - Street 2:
Practice Address - City:FORT DEPOSIT
Practice Address - State:AL
Practice Address - Zip Code:36032-4326
Practice Address - Country:US
Practice Address - Phone:334-392-9389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health