Healthcare Provider Details

I. General information

NPI: 1013839323
Provider Name (Legal Business Name): LATISIA MARIE DUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11103 COTTONWOOD PLZ APT 6
OMAHA NE
68164-3731
US

IV. Provider business mailing address

17021 HUNTINGTON AVE
OMAHA NE
68116-3807
US

V. Phone/Fax

Practice location:
  • Phone: 402-686-7580
  • Fax:
Mailing address:
  • Phone: 402-870-8329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: