Healthcare Provider Details

I. General information

NPI: 1356623664
Provider Name (Legal Business Name): LATASHA ANN HARRIS STNA, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 BEAUMONT DR
TOLEDO OH
43608-2201
US

IV. Provider business mailing address

3245 BEAUMONT DR
TOLEDO OH
43608-2201
US

V. Phone/Fax

Practice location:
  • Phone: 419-727-0964
  • Fax:
Mailing address:
  • Phone: 419-727-0964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number501064470106
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: