Provider Demographics
NPI:1316517873
Name:DEVAUGHN, LATOYA
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:DEVAUGHN
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 1:3608 ANDERSON PKWY
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4906
Mailing Address - Country:US
Mailing Address - Phone:419-917-6243
Mailing Address - Fax:
Practice Address - Street 1:3608 ANDERSON PKWY
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4906
Practice Address - Country:US
Practice Address - Phone:419-917-6243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care