Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife |
NPI | 1104451244 |
---|---|
Provider Name | Latia Dandridge |
First Address | Waldorf, MD 20603-4443 |
Second Address | Waldorf, MD 20603-4443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2020 |
Last Update Date | 22/02/2021 |