Provider Demographics
NPI:1760169692
Name:DRAKEFORD, LATICE
Entity Type:Individual
Prefix:MS
First Name:LATICE
Middle Name:
Last Name:DRAKEFORD
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 1:23696 TRAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-9308
Mailing Address - Country:US
Mailing Address - Phone:248-929-2216
Mailing Address - Fax:
Practice Address - Street 1:23696 TRAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-9308
Practice Address - Country:US
Practice Address - Phone:248-929-2216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health