Provider Demographics
NPI:1568289817
Name:KENDLE, LATISHA
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:
Last Name:KENDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TISH
Other - Middle Name:
Other - Last Name:KENDLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7190 RAMONA ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2651
Mailing Address - Country:US
Mailing Address - Phone:219-484-0819
Mailing Address - Fax:918-238-1017
Practice Address - Street 1:2424 FRANKLIN ST STE 203
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4562
Practice Address - Country:US
Practice Address - Phone:219-292-7555
Practice Address - Fax:918-238-1017
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN21-0148573747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant