Provider Demographics
NPI:1457009516
Name:ELLIOTT, LATIFAH (LPN)
Entity Type:Individual
Prefix:
First Name:LATIFAH
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S AMERICAN ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2108
Mailing Address - Country:US
Mailing Address - Phone:215-606-9336
Mailing Address - Fax:
Practice Address - Street 1:960 HARVEST DR
Practice Address - Street 2:#100
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422
Practice Address - Country:US
Practice Address - Phone:215-605-9336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN307969164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse