Provider Demographics
NPI:1306583000
Name:ANKROM, LATISHA LYNNE
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:LYNNE
Last Name:ANKROM
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 1:712 BICES RUN RD
Mailing Address - Street 2:
Mailing Address - City:SHINNSTON
Mailing Address - State:WV
Mailing Address - Zip Code:26431-6959
Mailing Address - Country:US
Mailing Address - Phone:304-694-8125
Mailing Address - Fax:
Practice Address - Street 1:712 BICES RUN RD
Practice Address - Street 2:
Practice Address - City:SHINNSTON
Practice Address - State:WV
Practice Address - Zip Code:26431-6959
Practice Address - Country:US
Practice Address - Phone:304-694-8125
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant