Provider Demographics
NPI:1932784451
Name:ALFORD, LATARONETTE (CNA)
Entity Type:Individual
Prefix:
First Name:LATARONETTE
Middle Name:
Last Name:ALFORD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E MANN ST
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-1912
Mailing Address - Country:US
Mailing Address - Phone:919-464-0843
Mailing Address - Fax:
Practice Address - Street 1:1402 CHICOPEE RD LOT 97
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-2163
Practice Address - Country:US
Practice Address - Phone:919-464-0843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34D2215985291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory