Provider Demographics
NPI:1659946614
Name:HARRIS, LATONYA M
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:M
Last Name:HARRIS
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 1:691 PINECREST AVE APT C5
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-2857
Mailing Address - Country:US
Mailing Address - Phone:434-213-5157
Mailing Address - Fax:
Practice Address - Street 1:691 PINECREST AVE APT C5
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-2857
Practice Address - Country:US
Practice Address - Phone:434-213-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT60477113172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver