Provider Demographics
NPI:1508473653
Name:PHARR, LATOIA (RN)
Entity Type:Individual
Prefix:
First Name:LATOIA
Middle Name:
Last Name:PHARR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22162 GASCONY AVE # L
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2574
Mailing Address - Country:US
Mailing Address - Phone:313-316-0620
Mailing Address - Fax:
Practice Address - Street 1:22162 GASCONY AVE # L
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2574
Practice Address - Country:US
Practice Address - Phone:313-316-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704350289163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health