Provider Demographics
NPI:1487499141
Name:EVANS, LATISHA M
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:M
Last Name:EVANS
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 1:13504 QUARTER POLE CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2971
Mailing Address - Country:US
Mailing Address - Phone:301-343-2941
Mailing Address - Fax:
Practice Address - Street 1:13504 QUARTER POLE CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-2971
Practice Address - Country:US
Practice Address - Phone:301-343-2941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator