Provider Demographics
NPI:1518274364
Name:WASHINGTON, LATISHA SHIROSE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LATISHA
Middle Name:SHIROSE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LATISHA
Other - Middle Name:SHIROSE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6202 DUPREE AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-3219
Mailing Address - Country:US
Mailing Address - Phone:314-440-7928
Mailing Address - Fax:
Practice Address - Street 1:6202 DUPREE AVE
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-3219
Practice Address - Country:US
Practice Address - Phone:314-440-7928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002003900163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator