Provider Demographics
NPI:1861828360
Name:CONRAD, LATONYA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:MARIE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 CARLYSLE ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-2952
Mailing Address - Country:US
Mailing Address - Phone:330-689-9443
Mailing Address - Fax:
Practice Address - Street 1:675 CARLYSLE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-2952
Practice Address - Country:US
Practice Address - Phone:330-689-9443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH409706163W00000X
OH142633MIV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse