Healthcare Provider Details

I. General information

NPI: 1427418656
Provider Name (Legal Business Name): YOLANDA YVETTE LATHAM MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 HAMLIN BLVD
INKSTER MI
48141-2206
US

IV. Provider business mailing address

2700 HAMLIN BLVD
INKSTER MI
48141-2206
US

V. Phone/Fax

Practice location:
  • Phone: 313-561-5100
  • Fax: 313-565-0309
Mailing address:
  • Phone: 313-561-5100
  • Fax: 313-565-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704235359
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: