Provider Demographics
NPI:1578034823
Name:YARBROUGH, LATIFAH LURIE (LPN)
Entity Type:Individual
Prefix:
First Name:LATIFAH
Middle Name:LURIE
Last Name:YARBROUGH
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 1:6507 MARSOL RD APT 705
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3517
Mailing Address - Country:US
Mailing Address - Phone:440-444-8597
Mailing Address - Fax:
Practice Address - Street 1:6507 MARSOL RD APT 705
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-3517
Practice Address - Country:US
Practice Address - Phone:440-444-8597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH170113164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH170113Medicaid