Provider Demographics
NPI:1598362931
Name:JONES, LATRICE
Entity Type:Individual
Prefix:
First Name:LATRICE
Middle Name:
Last Name:JONES
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 1:1920 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-1650
Mailing Address - Country:US
Mailing Address - Phone:410-572-7267
Mailing Address - Fax:410-847-2880
Practice Address - Street 1:1920 N MONROE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1650
Practice Address - Country:US
Practice Address - Phone:443-721-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251F00000X
374U00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Single Specialty
No251F00000XAgenciesHome Infusion
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty