Provider Demographics
NPI:1790199867
Name:LATONA, KIMBERLY (STNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LATONA
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 WICHERT DR
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3530
Mailing Address - Country:US
Mailing Address - Phone:330-958-2355
Mailing Address - Fax:
Practice Address - Street 1:2170 WICHERT DR
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3530
Practice Address - Country:US
Practice Address - Phone:330-958-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401502770413376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide