Provider Demographics
NPI:1477036283
Name:BASSIER, LATOYA TAMAINE
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:TAMAINE
Last Name:BASSIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 CARPENTER AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3351
Mailing Address - Country:US
Mailing Address - Phone:845-392-1535
Mailing Address - Fax:
Practice Address - Street 1:440 CARPENTER AVE APT 4
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3351
Practice Address - Country:US
Practice Address - Phone:845-392-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-08
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299895164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty