Provider Demographics
NPI:1336752328
Name:HICKS, LATASHA (CNA)
Entity type:Individual
Prefix:MISS
First Name:LATASHA
Middle Name:
Last Name:HICKS
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 1:800 PRITCHARD AVENUE EXT APT C15
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-1725
Mailing Address - Country:US
Mailing Address - Phone:919-591-7063
Mailing Address - Fax:
Practice Address - Street 1:800 PRITCHARD AVENUE EXT
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-1717
Practice Address - Country:US
Practice Address - Phone:919-591-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide