Provider Demographics
NPI:1760906366
Name:GARRETT, LATERRA
Entity Type:Individual
Prefix:
First Name:LATERRA
Middle Name:
Last Name:GARRETT
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:PO BOX 1174
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-0350
Mailing Address - Country:US
Mailing Address - Phone:520-413-3475
Mailing Address - Fax:
Practice Address - Street 1:44139 W MESCAL ST
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-4044
Practice Address - Country:US
Practice Address - Phone:313-970-6127
Practice Address - Fax:313-970-6127
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant