Provider Demographics
NPI:1497088538
Name:WARD, LATOSHA (CPED, CFM)
Entity Type:Individual
Prefix:MRS
First Name:LATOSHA
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:CPED, CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27588-0833
Mailing Address - Country:US
Mailing Address - Phone:919-435-0321
Mailing Address - Fax:
Practice Address - Street 1:M04 DAVISON BLDG
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0833
Practice Address - Country:US
Practice Address - Phone:919-435-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCPED3559174400000X
NCCFM02249174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist