Provider Demographics
NPI:1649952235
Name:HERVEY, LATEISHA DENISE
Entity type:Individual
Prefix:
First Name:LATEISHA
Middle Name:DENISE
Last Name:HERVEY
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 1:30713 HIDDEN PINES LN
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-7305
Mailing Address - Country:US
Mailing Address - Phone:313-740-2724
Mailing Address - Fax:
Practice Address - Street 1:30713 HIDDEN PINES LN
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-7305
Practice Address - Country:US
Practice Address - Phone:313-740-2724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker