Healthcare Provider Details

I. General information

NPI: 1548191174
Provider Name (Legal Business Name): LATOYA DICKERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 PLYMOUTH RD
BALTIMORE MD
21214-1530
US

IV. Provider business mailing address

5600 PLYMOUTH RD
BALTIMORE MD
21214-1530
US

V. Phone/Fax

Practice location:
  • Phone: 410-725-3558
  • Fax:
Mailing address:
  • Phone: 410-725-3558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberW21880901
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: