Provider Demographics
NPI:1427889534
Name:LATHAM, DANIELLE
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:LATHAM
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 1:2099 N LOVINGTON DR APT 204
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4391
Mailing Address - Country:US
Mailing Address - Phone:313-721-8745
Mailing Address - Fax:
Practice Address - Street 1:2099 N LOVINGTON DR APT 204
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4391
Practice Address - Country:US
Practice Address - Phone:313-721-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL350135488189251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health