Healthcare Provider Details

I. General information

NPI: 1114783545
Provider Name (Legal Business Name): LATASHA L WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2284 S BALLENGER HWY
FLINT MI
48503-3446
US

IV. Provider business mailing address

2284 S BALLENGER HWY
FLINT MI
48503-3446
US

V. Phone/Fax

Practice location:
  • Phone: 810-221-7871
  • Fax:
Mailing address:
  • Phone: 810-221-7871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: