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General NPI Number Information
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NPI Number | 1154071264
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Entity Type | Individual
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Provider Name | LATAYA DE JESUS NP
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Gender | Female
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 807 FARSON ST STE 203A
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City | BELPRE
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State | OH
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Zip | 45714-1069
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Country | US
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Telephone | 740-568-5687
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Fax | 740-376-6118
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Provider Business Mailing Address
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Address Line | 416 COLEGATE DR BLDG 3
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City | MARIETTA
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State | OH
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Zip | 45750-9549
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Country | US
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Telephone | 740-374-3526
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Fax | 740-374-3165
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 113014
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 0000837
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0031356
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License Number State | OH
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