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General NPI Number Information
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NPI Number | 1386987063
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Entity Type | Individual
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Provider Name | LATISHA ROCHELL CARTER LPN
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Gender | Female
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 248 W 108TH ST BRIDGE ACT TEAM
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City | NEW YORK
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State | NY
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Zip | 10025-2956
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Country | US
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Telephone | 631-872-3408
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Fax |
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Provider Business Mailing Address
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Address Line | 60 AMSTERDAM AVE APT 5B
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City | NEW YORK
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State | NY
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Zip | 10023-7417
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Country | US
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Telephone | 347-267-2353
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 227506
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License Number State | NY
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