Provider Demographics
NPI:1851012579
Name:WHITE-UPCHURCH, LATONYA A
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:A
Last Name:WHITE-UPCHURCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATONYA
Other - Middle Name:A
Other - Last Name:UPCHURCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4025 W GIRARD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-1031
Mailing Address - Country:US
Mailing Address - Phone:267-266-1339
Mailing Address - Fax:
Practice Address - Street 1:4025 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1031
Practice Address - Country:US
Practice Address - Phone:267-266-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion