Provider Demographics
NPI:1508607821
Name:TRIPLETT, LATONIA DEANN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:LATONIA
Middle Name:DEANN
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 NIGHTHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-4770
Mailing Address - Country:US
Mailing Address - Phone:317-912-1141
Mailing Address - Fax:317-536-3196
Practice Address - Street 1:5435 NIGHTHAWK WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4770
Practice Address - Country:US
Practice Address - Phone:317-912-1141
Practice Address - Fax:317-536-3196
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28163767A163W00000X, 163WI0500X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No163W00000XNursing Service ProvidersRegistered Nurse
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy