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General NPI Number Information
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NPI Number | 1144051962
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Entity Type | Individual
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Provider Name | LATISE SHEVONNE ESTRIDGE
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Gender | Female
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 7271 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45415-2567
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Country | US
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Telephone | 937-203-4928
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Fax | 937-630-4618
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Provider Business Mailing Address
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Address Line | 1828 WESLEYAN RD
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City | DAYTON
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State | OH
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Zip | 45406-3945
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Country | US
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Telephone | 937-581-5279
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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