Individual
MISS LATASHA FAYE BANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1709 N SHADELAND AVE, INDIANAPOLIS, IN 46219-2733
(317) 709-7365
Mailing address
1709 N SHADELAND AVE, INDIANAPOLIS, IN 46219-2733
(317) 709-7365
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
210054541
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21-005454-1
ISDH
IN
Enumeration date
12/14/2021
Last updated
12/14/2021
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