Provider Demographics
NPI:1487280970
Name:TAYLOR, LATASHA NICHELLE (LPN)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:NICHELLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 HANCHEY RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35214-2007
Mailing Address - Country:US
Mailing Address - Phone:205-337-1457
Mailing Address - Fax:
Practice Address - Street 1:1949 HANCHEY RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35214-2007
Practice Address - Country:US
Practice Address - Phone:205-337-1457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-064691164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse