Provider Demographics
NPI:1417456625
Name:CRENSHAW, LATONYA (STNA)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8006 MEDINA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-2216
Mailing Address - Country:US
Mailing Address - Phone:216-258-3632
Mailing Address - Fax:
Practice Address - Street 1:8006 MEDINA AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-2216
Practice Address - Country:US
Practice Address - Phone:216-258-3632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide