Provider Demographics
NPI:1801662374
Name:MCCALL, LATYA ONJALEK (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LATYA
Middle Name:ONJALEK
Last Name:MCCALL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5873 SPYGLASS DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-2602
Mailing Address - Country:US
Mailing Address - Phone:251-508-5553
Mailing Address - Fax:
Practice Address - Street 1:3202 OLD SHELL RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-2505
Practice Address - Country:US
Practice Address - Phone:251-301-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-174336171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider