Provider Demographics
NPI:1740817147
Name:BARNES, LATANYA L (RN)
Entity type:Individual
Prefix:
First Name:LATANYA
Middle Name:L
Last Name:BARNES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7074 INGRAHM DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8358
Mailing Address - Country:US
Mailing Address - Phone:443-889-1866
Mailing Address - Fax:
Practice Address - Street 1:1232 RACE ROAD
Practice Address - Street 2:STE 403
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2123
Practice Address - Country:US
Practice Address - Phone:443-868-7101
Practice Address - Fax:443-732-0054
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183346163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse