Provider Demographics
NPI:1659048023
Name:STAPLETON, LATISHA NICOLE (CD, CLC)
Entity Type:Individual
Prefix:MRS
First Name:LATISHA
Middle Name:NICOLE
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:CD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 E 103RD PL FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2906
Mailing Address - Country:US
Mailing Address - Phone:773-595-9918
Mailing Address - Fax:855-706-5563
Practice Address - Street 1:619 E 103RD PL FL 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2906
Practice Address - Country:US
Practice Address - Phone:773-595-9918
Practice Address - Fax:855-706-5563
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty