Provider Demographics
NPI:1588498596
Name:WALKER WHITE, LATANISHA MONIQUE
Entity type:Individual
Prefix:MRS
First Name:LATANISHA
Middle Name:MONIQUE
Last Name:WALKER WHITE
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 1:1601 CYPRESS E
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4024
Mailing Address - Country:US
Mailing Address - Phone:216-650-1914
Mailing Address - Fax:
Practice Address - Street 1:1601 CYPRESS E
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4024
Practice Address - Country:US
Practice Address - Phone:216-650-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCHW.001381172V00000X
OH374J00000X374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH374J00000XMedicaid