Provider Demographics
NPI:1912696873
Name:WARD, LATAVIA
Entity Type:Individual
Prefix:
First Name:LATAVIA
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 FLEMING DR APT 1001A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77013-6046
Mailing Address - Country:US
Mailing Address - Phone:706-513-6204
Mailing Address - Fax:
Practice Address - Street 1:12200 FLEMING DR APT 1001A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77013-6046
Practice Address - Country:US
Practice Address - Phone:706-513-6204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider