Healthcare Provider Details

I. General information

NPI: 1609519172
Provider Name (Legal Business Name): LATISHA MARIE EFAW LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28407 STATE ROUTE 7
MARIETTA OH
45750-5152
US

IV. Provider business mailing address

28407 STATE ROUTE 7
MARIETTA OH
45750-5152
US

V. Phone/Fax

Practice location:
  • Phone: 740-371-6476
  • Fax:
Mailing address:
  • Phone: 740-371-5476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number116845
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: