Provider Demographics
NPI:1194462721
Name:CAMERON, LATISHA JADE (CNA)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:JADE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 TRYON CT W
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-7422
Mailing Address - Country:US
Mailing Address - Phone:910-033-6095
Mailing Address - Fax:
Practice Address - Street 1:54 TRYON CT W
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-7422
Practice Address - Country:US
Practice Address - Phone:910-033-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC444497376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide