Provider Demographics
NPI:1356623664
Name:HARRIS, LATASHA ANN (STNA, MA)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:STNA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 BEAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2201
Mailing Address - Country:US
Mailing Address - Phone:419-727-0964
Mailing Address - Fax:
Practice Address - Street 1:3245 BEAUMONT DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2201
Practice Address - Country:US
Practice Address - Phone:419-727-0964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH501064470106376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide