Provider Demographics
NPI:1982875738
Name:LATHAM, DONMONIQUE LASHELL
Entity Type:Individual
Prefix:MS
First Name:DONMONIQUE
Middle Name:LASHELL
Last Name:LATHAM
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 1:1442 E HUDSON ST # SY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-1470
Mailing Address - Country:US
Mailing Address - Phone:614-447-1802
Mailing Address - Fax:
Practice Address - Street 1:1442 E HUDSON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1470
Practice Address - Country:US
Practice Address - Phone:614-447-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide