Provider Demographics
NPI:1710533831
Name:FIELDS, LA'TONYA
Entity Type:Individual
Prefix:
First Name:LA'TONYA
Middle Name:
Last Name:FIELDS
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 1:8706 QUEENSMERE PL APT 7
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4865
Mailing Address - Country:US
Mailing Address - Phone:757-389-3292
Mailing Address - Fax:
Practice Address - Street 1:8706 QUEENSMERE PL APT 7
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4865
Practice Address - Country:US
Practice Address - Phone:757-389-3292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor