Provider Demographics
NPI:1558671990
Name:ROBERTSON, LATONYA R (LPN)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:R
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6202 GREENS HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2110
Mailing Address - Country:US
Mailing Address - Phone:919-641-4630
Mailing Address - Fax:
Practice Address - Street 1:6202 GREENS HOLLOW LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2110
Practice Address - Country:US
Practice Address - Phone:919-641-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC060425164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse