Provider Demographics
NPI:1295551430
Name:ANDREWS, LATHYIA (DSP, CNA)
Entity type:Individual
Prefix:
First Name:LATHYIA
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:DSP, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 S WALNUT ST # 4
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-2362
Mailing Address - Country:US
Mailing Address - Phone:330-840-8780
Mailing Address - Fax:
Practice Address - Street 1:3901 EDGEMONT ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2619
Practice Address - Country:US
Practice Address - Phone:330-445-6927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2947877422Medicaid