Provider Demographics
NPI:1750142956
Name:MOORMAN, LATONYA M (LPN)
Entity type:Individual
Prefix:MS
First Name:LATONYA
Middle Name:M
Last Name:MOORMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LATONYA
Other - Middle Name:M
Other - Last Name:MOORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:607 SHELBY ST STE 700-1361
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-3268
Mailing Address - Country:US
Mailing Address - Phone:313-978-3509
Mailing Address - Fax:
Practice Address - Street 1:607 SHELBY ST STE 700-1361
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3268
Practice Address - Country:US
Practice Address - Phone:313-978-3509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health