Provider Demographics
NPI:1134998495
Name:WHATLEY, LATASHA B
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:B
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 E 120TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-4546
Mailing Address - Country:US
Mailing Address - Phone:216-313-1550
Mailing Address - Fax:
Practice Address - Street 1:3925 E 120TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-4546
Practice Address - Country:US
Practice Address - Phone:216-313-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide