Individual provider · NPI-1

Latoya Crockett

Homemaker · Charlotte, NC

NPI number1841811403
StatusActive
Last updated in NPPESMay 5, 2020

Details

NPI
1841811403
Entity type
Individual (NPI-1)
Name
Latoya Crockett
Sex
Female
Sole proprietor
No
Enumeration date
May 5, 2020
Certification date
May 5, 2020
Last updated
May 5, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
376J00000X Homemaker–NCYes

Practice location

3325 Washburn Ave
Charlotte, NC 28205-7024

Phone 704-340-4414

Mailing address

2226 Waters Trail Dr
Charlotte, NC 28216-8800

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