Provider Demographics
NPI:1154706448
Name:ANDERSON, LATONYA YVETTE
Entity type:Individual
Prefix:MRS
First Name:LATONYA
Middle Name:YVETTE
Last Name:ANDERSON
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 1:615 SAINT GEORGE SQUARE CT
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1356
Mailing Address - Country:US
Mailing Address - Phone:336-287-4841
Mailing Address - Fax:
Practice Address - Street 1:615 SAINT GEORGE SQUARE CT
Practice Address - Street 2:SUITE 300
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1356
Practice Address - Country:US
Practice Address - Phone:336-287-4841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care