Individual
MRS. LATEISHA LYNN VANTRICE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
1839 N 39TH ST, PHOENIX, AZ 85008-3915
(817) 819-7710
Mailing address
1839 N 39TH ST, PHOENIX, AZ 85008-3915
(817) 819-7710
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
297178
AZ
Other
Enumeration date
04/21/2025
Last updated
04/21/2025
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