Provider Demographics
NPI:1245664051
Name:MARK, LATONYA C (LPN)
Entity type:Individual
Prefix:MS
First Name:LATONYA
Middle Name:C
Last Name:MARK
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 1:29 SUNLIGHT CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:MS
Mailing Address - Zip Code:39478-9469
Mailing Address - Country:US
Mailing Address - Phone:601-310-0757
Mailing Address - Fax:601-843-0190
Practice Address - Street 1:29 SUNLIGHT CHURCH RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:MS
Practice Address - Zip Code:39478-9469
Practice Address - Country:US
Practice Address - Phone:601-810-5427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP323893376G00000X
LA280601390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program