Provider Demographics
NPI:1962174466
Name:LATTIMORE, MARCHELLA LASHAY
Entity type:Individual
Prefix:
First Name:MARCHELLA
Middle Name:LASHAY
Last Name:LATTIMORE
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 1:13516 KELSO AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-2154
Mailing Address - Country:US
Mailing Address - Phone:216-205-3751
Mailing Address - Fax:
Practice Address - Street 1:13516 KELSO AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-2154
Practice Address - Country:US
Practice Address - Phone:216-205-3751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide