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General NPI Number Information
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NPI Number | 1740996743
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Entity Type | Individual
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Provider Name | LATANYA BRUTON LPN
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Gender | Female
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 20870 ISHERWOOD TER APT 300
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City | ASHBURN
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State | VA
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Zip | 20147-7790
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Country | US
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Telephone | 850-382-6840
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Fax |
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Provider Business Mailing Address
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Address Line | 6901A N 9TH AVE # 566
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City | PENSACOLA
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State | FL
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Zip | 32504-6638
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Country | US
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Telephone | 850-417-1188
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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 | PN5172428
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License Number State | FL
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