Provider Demographics
NPI:1992213342
Name:HALLUM, LATANYA DENISE (RN)
Entity Type:Individual
Prefix:MS
First Name:LATANYA
Middle Name:DENISE
Last Name:HALLUM
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 1:3205 CHARING CROSS RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-1281
Mailing Address - Country:US
Mailing Address - Phone:682-261-7826
Mailing Address - Fax:
Practice Address - Street 1:3205 CHARING CROSS RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-1281
Practice Address - Country:US
Practice Address - Phone:682-261-7826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX932956171M00000X, 163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty