Provider Demographics
NPI:1316479462
Name:SMITH, LATESHA GERMAINE (LPN)
Entity type:Individual
Prefix:
First Name:LATESHA
Middle Name:GERMAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 MADISON AVE APT 6H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3869
Mailing Address - Country:US
Mailing Address - Phone:347-821-6171
Mailing Address - Fax:
Practice Address - Street 1:1590 MADISON AVE APT 6H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3869
Practice Address - Country:US
Practice Address - Phone:347-821-6171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324064164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse