Provider Demographics
NPI:1467253757
Name:DANIELS, LATECHA
Entity type:Individual
Prefix:
First Name:LATECHA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 CAROLINA CT
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46323-2703
Mailing Address - Country:US
Mailing Address - Phone:270-268-5733
Mailing Address - Fax:
Practice Address - Street 1:7015 CAROLINA CT
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46323-2703
Practice Address - Country:US
Practice Address - Phone:270-268-5733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28251772A163WA0400X, 163WC1500X, 163WC1600X, 163WD0400X, 163WG0000X, 163WG0600X, 163WI0600X, 163WM0705X, 163WP0807X, 163WP0808X, 163WR0400X, 163WX0106X, 174H00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
No174H00000XOther Service ProvidersHealth Educator