Provider Demographics
NPI:1699217307
Name:MALONE, LATONYA (LPN)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:MALONE
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 1:671 CLAIRE LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-6642
Mailing Address - Country:US
Mailing Address - Phone:757-881-9230
Mailing Address - Fax:757-881-9230
Practice Address - Street 1:671 CLAIRE LN
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-6642
Practice Address - Country:US
Practice Address - Phone:757-881-9230
Practice Address - Fax:757-881-9230
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002081389164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse