Provider Demographics
NPI:1811436983
Name:COLLIER, DANASHA LATIA (LPN)
Entity type:Individual
Prefix:
First Name:DANASHA
Middle Name:LATIA
Last Name:COLLIER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7204 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4819
Mailing Address - Country:US
Mailing Address - Phone:330-988-5737
Mailing Address - Fax:
Practice Address - Street 1:7204 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4819
Practice Address - Country:US
Practice Address - Phone:330-988-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.159025.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse