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General NPI Number Information
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NPI Number | 1225451792
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Entity Type | Individual
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Provider Name | LATRICE ANDERSON R.N.
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Gender | Female
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 9303 STONESTREET RD #204
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City | LOUISVILLE
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State | KY
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Zip | 40272-2864
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Country | US
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Telephone | 502-407-7723
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Fax |
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Provider Business Mailing Address
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Address Line | 9303 STONESTREET RD #204
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City | LOUISVILLE
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State | KY
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Zip | 40272-2864
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Country | US
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Telephone |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 5009
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1098780
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License Number State | KY
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