Provider Demographics
NPI:1578346490
Name:FOLEY, LATISA L
Entity Type:Individual
Prefix:
First Name:LATISA
Middle Name:L
Last Name:FOLEY
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 1:4255 WESTBROOK DR STE 203
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8125
Mailing Address - Country:US
Mailing Address - Phone:630-692-3991
Mailing Address - Fax:
Practice Address - Street 1:4255 WESTBROOK DR STE 203
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8125
Practice Address - Country:US
Practice Address - Phone:630-692-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver