Healthcare Provider Details

I. General information

NPI: 1780221069
Provider Name (Legal Business Name): LATCH LADIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6416 LANSDALE RD
FORT WORTH TX
76116-1624
US

IV. Provider business mailing address

6416 LANSDALE RD
FORT WORTH TX
76116-1624
US

V. Phone/Fax

Practice location:
  • Phone: 817-456-1217
  • Fax:
Mailing address:
  • Phone: 817-456-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SALLY DAVIDSON ZUKOSKI
Title or Position: OWNER
Credential: RN, IBCLC
Phone: 817-456-1217