Provider Demographics
NPI:1356685127
Name:LAWSON, LATEVI AYEDEDJI (HHA)
Entity type:Individual
Prefix:MR
First Name:LATEVI
Middle Name:AYEDEDJI
Last Name:LAWSON
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 64TH AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1508
Mailing Address - Country:US
Mailing Address - Phone:240-551-2237
Mailing Address - Fax:
Practice Address - Street 1:6309 64TH AVE
Practice Address - Street 2:APT 3
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1508
Practice Address - Country:US
Practice Address - Phone:240-551-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide