Provider Demographics
NPI:1912733510
Name:LYNN, LATRISHA (CNA)
Entity type:Individual
Prefix:
First Name:LATRISHA
Middle Name:
Last Name:LYNN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:LATRISHA
Other - Middle Name:
Other - Last Name:LYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:2 TRESTLEWOOD CT APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 TRESTLEWOOD CT APT B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2920
Practice Address - Country:US
Practice Address - Phone:334-689-3357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0014221893374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide