Provider Demographics
NPI:1013458017
Name:CRUMPLER, LATARSHA (NUANGELS HOME CARE)
Entity Type:Individual
Prefix:MRS
First Name:LATARSHA
Middle Name:
Last Name:CRUMPLER
Suffix:
Gender:F
Credentials:NUANGELS HOME CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 CARRIAGE CT
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9453
Mailing Address - Country:US
Mailing Address - Phone:919-672-5592
Mailing Address - Fax:
Practice Address - Street 1:1106 W CORNWALLIS RD
Practice Address - Street 2:SUITE 105
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-5748
Practice Address - Country:US
Practice Address - Phone:984-244-7835
Practice Address - Fax:919-573-9158
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1245656578Medicaid