Provider Demographics
NPI:1457109019
Name:LATTA, MY'CHELLE
Entity Type:Individual
Prefix:
First Name:MY'CHELLE
Middle Name:
Last Name:LATTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 A ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6517
Mailing Address - Country:US
Mailing Address - Phone:202-380-7711
Mailing Address - Fax:
Practice Address - Street 1:3509 18TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2209
Practice Address - Country:US
Practice Address - Phone:202-459-3826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant