Provider Demographics
NPI:1467222414
Name:SAMUELS, LATISHA (LPN)
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:
Last Name:SAMUELS
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 1:364 WONDER DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:76082-6147
Mailing Address - Country:US
Mailing Address - Phone:303-886-7682
Mailing Address - Fax:
Practice Address - Street 1:364 WONDER DR
Practice Address - Street 2:
Practice Address - City:SPRINGTOWN
Practice Address - State:TX
Practice Address - Zip Code:76082-6147
Practice Address - Country:US
Practice Address - Phone:303-886-7682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073799164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse