Healthcare Provider Details

I. General information

NPI: 1356929285
Provider Name (Legal Business Name): LATASHA BATTLE COSMETOLOGY LICENSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATASHA YVETTE BATTLE HAIR LOSS SPECIALIST

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 MILLER RD
GREENVILLE SC
29607-6540
US

IV. Provider business mailing address

360 ROSSON LN APT C201
SPARTANBURG SC
29301-2678
US

V. Phone/Fax

Practice location:
  • Phone: 864-283-0555
  • Fax:
Mailing address:
  • Phone: 864-216-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: