Provider Demographics
NPI:1407208051
Name:MABRY, LATILL
Entity Type:Individual
Prefix:
First Name:LATILL
Middle Name:
Last Name:MABRY
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 1:82 GALVESTON ST SW
Mailing Address - Street 2:APT T1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-1987
Mailing Address - Country:US
Mailing Address - Phone:202-677-9021
Mailing Address - Fax:
Practice Address - Street 1:82 GALVESTON ST SW
Practice Address - Street 2:APT T1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1987
Practice Address - Country:US
Practice Address - Phone:202-677-9021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide