Provider Demographics
NPI:1386987063
Name:CARTER, LATISHA ROCHELL (LPN)
Entity type:Individual
Prefix:MS
First Name:LATISHA
Middle Name:ROCHELL
Last Name:CARTER
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 1:60 AMSTERDAM AVE
Mailing Address - Street 2:APT 5B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7417
Mailing Address - Country:US
Mailing Address - Phone:347-267-2353
Mailing Address - Fax:
Practice Address - Street 1:248 W 108TH ST
Practice Address - Street 2:BRIDGE ACT TEAM
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2956
Practice Address - Country:US
Practice Address - Phone:631-872-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227506164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse