Provider Demographics
NPI:1285238915
Name:RILEY, LATASHA LATRELL
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:LATRELL
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 MCMILLAN CIR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-2100
Mailing Address - Country:US
Mailing Address - Phone:330-328-7748
Mailing Address - Fax:
Practice Address - Street 1:1264 MCMILLAN CIR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-2100
Practice Address - Country:US
Practice Address - Phone:330-328-7748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker