Provider Demographics
NPI:1487191631
Name:ELDER, LATAREN D
Entity Type:Individual
Prefix:
First Name:LATAREN
Middle Name:D
Last Name:ELDER
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 1:18683 CODDING ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2214
Mailing Address - Country:US
Mailing Address - Phone:626-710-5475
Mailing Address - Fax:
Practice Address - Street 1:18683 CODDING ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2214
Practice Address - Country:US
Practice Address - Phone:626-710-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide