Provider Demographics
NPI:1417607581
Name:GILMORE, LATONYA (CNA)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:GILMORE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 CRUCIBLE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-4801
Mailing Address - Country:US
Mailing Address - Phone:412-610-4216
Mailing Address - Fax:
Practice Address - Street 1:1021 CRUCIBLE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-4801
Practice Address - Country:US
Practice Address - Phone:412-610-4216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA644543601Medicaid