Provider Demographics
NPI:1710879630
Name:BRADFORD, LATASHA (EN)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:EN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 LANDON PL
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-4291
Mailing Address - Country:US
Mailing Address - Phone:336-334-2389
Mailing Address - Fax:
Practice Address - Street 1:28 LANDON PL
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4291
Practice Address - Country:US
Practice Address - Phone:336-334-2389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363784163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse