Provider Demographics
NPI:1184288193
Name:KNOWLES, LATASHA (LPN)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26900 GEORGE ZEIGER DR APT 313
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7610
Mailing Address - Country:US
Mailing Address - Phone:216-894-1337
Mailing Address - Fax:
Practice Address - Street 1:6700 PEARL RD
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3828
Practice Address - Country:US
Practice Address - Phone:440-941-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.171140.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse