Provider Demographics
NPI:1841842739
Name:ROSS, ODEL LATANA (HHA)
Entity type:Individual
Prefix:MRS
First Name:ODEL
Middle Name:LATANA
Last Name:ROSS
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:MRS
Other - First Name:ODEL
Other - Middle Name:LATANA
Other - Last Name:ROSS
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:138 42ND ST NE APT C32
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4523
Mailing Address - Country:US
Mailing Address - Phone:202-706-9304
Mailing Address - Fax:
Practice Address - Street 1:138 42ND ST NE APT C32
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4523
Practice Address - Country:US
Practice Address - Phone:202-706-9304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14540374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide