MEDICARE: LATRINA KINGSBY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	168145	WI

General Provider Information

NPI Number	:	1164185773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATRINA KINGSBY RN

Provider Business Mailing Address
First Line	:	7034 N 55TH ST APT C
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-6336
Country	:	US
Telephone Number	:	414-405-9002
Fax Number	:

Provider Business Practice Location Address
First Line	:	4911 W GOOD HOPE RD UNIT D
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-4840
Country	:	US
Telephone Number	:	414-405-9002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2021
Last Update Date	:	10/20/2021

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