Provider Demographics
NPI:1548764996
Name:DORSEY, LATOUSHA
Entity Type:Individual
Prefix:
First Name:LATOUSHA
Middle Name:
Last Name:DORSEY
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 1:2310 RIVERWOOD DR STE C
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3498
Mailing Address - Country:US
Mailing Address - Phone:318-458-1513
Mailing Address - Fax:
Practice Address - Street 1:2310 RIVERWOOD DR STE C
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3498
Practice Address - Country:US
Practice Address - Phone:318-458-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3737601744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1744P3200XOtherCERTIFIED HAIR LOSS SPECIALIST