Individual
LATASHA ELAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
11390 W THEODORE TRECKER WAY, WEST ALLIS, WI 53214-1135
(414) 928-1401
Mailing address
11390 W THEODORE TRECKER WAY, WEST ALLIS, WI 53214-1135
(414) 928-1401
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
314509
WI
Other
Enumeration date
12/20/2022
Last updated
12/20/2022
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