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NPI Code Detail

MEDICARE: SHADONNA LATIMORE

MEDICARE: SHADONNA LATIMORE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1253J00000XFoster Care Agency

General Provider Information

NPI Number : 1235475328
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHADONNA LATIMORE
Provider Business Mailing Address
First Line : 3155 E PATRICK LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-3496
Country : US
Telephone Number : 702-992-0576
Fax Number : 108-992-0391
Provider Business Practice Location Address
First Line : 3155 E PATRICK LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-3496
Country : US
Telephone Number : 702-992-0576
Fax Number : 108-992-0391
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2012
Last Update Date : 12/18/2012

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1083054290 — SARAH THOMAS
Practice Location Address:
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Directions to “ SHADONNA LATIMORE ” Practice Location

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