Individual provider · NPI-1
Latisha Marie Abbott Edison
Nursing Home Administrator · Portsmouth, VA
NPI number1568239242
StatusActive
Last updated in NPPESDec 4, 2023
Details
- NPI
- 1568239242
- Entity type
- Individual (NPI-1)
- Name
- Latisha Marie Abbott Edison
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 4, 2023
- Certification date
- Dec 4, 2023
- Last updated
- Dec 4, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 376G00000X | Nursing Home Administrator | – | – | Yes |
Practice location
4000 Dartmouth StPortsmouth, VA 23707-3816
Phone 757-920-8841
Mailing address
4000 Dartmouth StPortsmouth, VA 23707-3816
Phone 757-920-8841
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