Provider Demographics
NPI:1538464722
Name:STEWART, LATREICE (LVN)
Entity Type:Individual
Prefix:
First Name:LATREICE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43649 RIALTO DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-6156
Mailing Address - Country:US
Mailing Address - Phone:323-218-3327
Mailing Address - Fax:
Practice Address - Street 1:11273 THORSON AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2842
Practice Address - Country:US
Practice Address - Phone:323-218-3327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN143427164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse