MEDICARE: LATANYA MONFORD

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	376K00000X	Nurse's Aide	324867510208	OH
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1770165144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATANYA MONFORD

Provider Business Mailing Address
First Line	:	2501 14TH ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-1935
Country	:	US
Telephone Number	:	330-605-1183
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 14TH ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-1935
Country	:	US
Telephone Number	:	330-605-1183
Fax Number	:

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

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	04/26/2021

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Directions to “ LATANYA MONFORD ” Practice Location

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