Provider Demographics
NPI:1225860166
Name:LATHAN, KORIANA LATRICE
Entity type:Individual
Prefix:
First Name:KORIANA
Middle Name:LATRICE
Last Name:LATHAN
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 1:4122 S ANDES WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-3830
Mailing Address - Country:US
Mailing Address - Phone:303-253-0083
Mailing Address - Fax:
Practice Address - Street 1:4122 S ANDES WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-3830
Practice Address - Country:US
Practice Address - Phone:303-253-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion