Healthcare Provider Details

I. General information

NPI: 1871956763
Provider Name (Legal Business Name): LATOSHIA REESE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 01/16/2022
Certification Date: 01/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

BLDG 11582 C ST AND 17TH ST
JBLM WA
98433
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3972
  • Fax: 253-968-4573
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN00149594
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: