Provider Demographics
NPI:1568234607
Name:ADAMAH, LATRE FAFA
Entity Type:Individual
Prefix:
First Name:LATRE
Middle Name:FAFA
Last Name:ADAMAH
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 1:2419 GRIFFITH MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6300
Mailing Address - Country:US
Mailing Address - Phone:704-492-4375
Mailing Address - Fax:
Practice Address - Street 1:2419 GRIFFITH MEADOWS DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6300
Practice Address - Country:US
Practice Address - Phone:704-492-4375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF10230737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily