MEDICARE: LATOSHA MONEKE WEBB

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1417224502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOSHA MONEKE WEBB

Provider Business Mailing Address
First Line	:	3205 COUNTRY CREEK LN.
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3542
Country	:	US
Telephone Number	:	817-253-2294
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 COUNTRY CREEK LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1223
Country	:	US
Telephone Number	:	817-253-2294
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2011
Last Update Date	:	01/28/2013

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