Provider Demographics
NPI:1669020111
Name:COLE, LATASHA ANN
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:ANN
Last Name:COLE
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 1:3249 WESTDALE CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2917
Mailing Address - Country:US
Mailing Address - Phone:202-486-6389
Mailing Address - Fax:
Practice Address - Street 1:1941 NAYLOR RD SE APT B
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6819
Practice Address - Country:US
Practice Address - Phone:202-568-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant