Provider Demographics
NPI:1669706792
Name:RUMPH, LATASHA RENEE
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:RENEE
Last Name:RUMPH
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 1:1825 PONTIAC DR
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2230
Mailing Address - Country:US
Mailing Address - Phone:216-632-3544
Mailing Address - Fax:
Practice Address - Street 1:1825 PONTIAC DR
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2230
Practice Address - Country:US
Practice Address - Phone:216-632-3544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN128195-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse