Individual
LATISHA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
810 N 107TH AVE APT 301, OMAHA, NE 68114-2042
(402) 612-1856
Mailing address
810 N 107TH AVE APT 301, OMAHA, NE 68114-2042
(402) 612-1856
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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