Provider Demographics
NPI:1932757309
Name:BALL, LATISHA MICHELLE
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:MICHELLE
Last Name:BALL
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:PO BOX 2586
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20013-2586
Mailing Address - Country:US
Mailing Address - Phone:202-702-7145
Mailing Address - Fax:
Practice Address - Street 1:400 ATLANTIC ST SE # 202
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3702
Practice Address - Country:US
Practice Address - Phone:202-290-7362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide