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Individual
LATISHA BLACK
Active
Individual
LATISHA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
56246
NE
363LG0600X
Gerontology Nurse Practitioner
Primary
112100
NE
363LG0600X
Gerontology Nurse Practitioner
H156127
IA
Other
Enumeration date
07/25/2016
Last updated
11/13/2025
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