Provider Demographics
NPI:1851992622
Name:LATHON, DESTINEE (CNA)
Entity Type:Individual
Prefix:
First Name:DESTINEE
Middle Name:
Last Name:LATHON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 FAIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-2927
Mailing Address - Country:US
Mailing Address - Phone:217-953-1004
Mailing Address - Fax:
Practice Address - Street 1:1731 FAIRMONT DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-2927
Practice Address - Country:US
Practice Address - Phone:217-953-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide