Provider Demographics
NPI:1295484103
Name:MADRIGAL, LATASHA LYNN (RN, BSN)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:LYNN
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:
Other - Last Name:MAYNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:9408 NE 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-2172
Mailing Address - Country:US
Mailing Address - Phone:360-448-5406
Mailing Address - Fax:
Practice Address - Street 1:9408 NE 104TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-2172
Practice Address - Country:US
Practice Address - Phone:360-448-5406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60733051163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse