Provider Demographics
NPI:1174993026
Name:WESTON, LATANYA NIKKOLE (NP-C)
Entity type:Individual
Prefix:
First Name:LATANYA
Middle Name:NIKKOLE
Last Name:WESTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LATANYA
Other - Middle Name:NIKKOLE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2051 KAEN RD
Mailing Address - Street 2:367
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4035
Mailing Address - Country:US
Mailing Address - Phone:503-650-3110
Mailing Address - Fax:
Practice Address - Street 1:1425 BEAVERCREEK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045
Practice Address - Country:US
Practice Address - Phone:503-655-8471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201609584NP-PP363L00000X
GARN 188640363L00000X
VA0024176026363LP2300X
WAAP60726772363LP2300X
GARN188640363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner