Individual
LATASHA RENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STUDENT
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
—
—
405300000X
Prevention Professional
Primary
1270112
TX
Other
Enumeration date
10/09/2023
Last updated
10/09/2023
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