Provider Demographics
NPI:1922770791
Name:SAPP, LA'TRAVEIN (RN)
Entity Type:Individual
Prefix:
First Name:LA'TRAVEIN
Middle Name:
Last Name:SAPP
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 GROVE BND
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2706
Mailing Address - Country:US
Mailing Address - Phone:404-983-6393
Mailing Address - Fax:
Practice Address - Street 1:798 GROVE BND
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2706
Practice Address - Country:US
Practice Address - Phone:404-983-6393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA296536163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse