Provider Demographics
NPI:1609397652
Name:THORPE, LATASHI (LPN)
Entity Type:Individual
Prefix:
First Name:LATASHI
Middle Name:
Last Name:THORPE
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:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:IRWINTON
Mailing Address - State:GA
Mailing Address - Zip Code:31042-0040
Mailing Address - Country:US
Mailing Address - Phone:478-595-1344
Mailing Address - Fax:
Practice Address - Street 1:114 CHURCH ST
Practice Address - Street 2:
Practice Address - City:IRWINTON
Practice Address - State:GA
Practice Address - Zip Code:31042-2557
Practice Address - Country:US
Practice Address - Phone:478-595-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059037164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
059037OtherLPN