Provider Demographics
NPI:1558098202
Name:STEPHENS, LATONIA MARIE
Entity Type:Individual
Prefix:
First Name:LATONIA
Middle Name:MARIE
Last Name:STEPHENS
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 1:5025 NELLIS OASIS LN APT 17
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-0763
Mailing Address - Country:US
Mailing Address - Phone:702-559-3024
Mailing Address - Fax:
Practice Address - Street 1:3940 N MARTIN LUTHER KING BLVD
Practice Address - Street 2:B106
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-476-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant