Provider Demographics
NPI:1629255229
Name:DAMON, LATANYA YVETTE
Entity Type:Individual
Prefix:MRS
First Name:LATANYA
Middle Name:YVETTE
Last Name:DAMON
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 1:201 HIGH POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-7608
Mailing Address - Country:US
Mailing Address - Phone:803-786-2767
Mailing Address - Fax:
Practice Address - Street 1:201 HIGH POINTE DR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-7608
Practice Address - Country:US
Practice Address - Phone:803-786-2767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR102475163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse