Provider Demographics
NPI:1841784683
Name:LATTIMORE, IESHEA APRYL
Entity Type:Individual
Prefix:
First Name:IESHEA
Middle Name:APRYL
Last Name:LATTIMORE
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 1:115 TOM CHAPMAN BLVD APT 702
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7850
Mailing Address - Country:US
Mailing Address - Phone:260-602-2611
Mailing Address - Fax:
Practice Address - Street 1:115 TOM CHAPMAN BLVD APT 702
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7850
Practice Address - Country:US
Practice Address - Phone:260-602-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula