Provider Demographics
NPI:1912639543
Name:BLADE, LATISHA (STNA)
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:
Last Name:BLADE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3393 KILDARE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2962
Mailing Address - Country:US
Mailing Address - Phone:216-474-6730
Mailing Address - Fax:
Practice Address - Street 1:3393 KILDARE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2962
Practice Address - Country:US
Practice Address - Phone:216-474-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400027850901376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide