Provider Demographics
NPI:1457092082
Name:DORRIS, LATARIKA L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LATARIKA
Middle Name:L
Last Name:DORRIS
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 1:106 S COUNTRY FAIR DR STE C
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-3064
Mailing Address - Country:US
Mailing Address - Phone:217-373-8200
Mailing Address - Fax:217-373-5233
Practice Address - Street 1:106 S COUNTRY FAIR DR STE C
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-3064
Practice Address - Country:US
Practice Address - Phone:217-373-8200
Practice Address - Fax:217-373-5233
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.11560164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse