Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | F0117016 | IN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 71007215A | IN |
NPI | 1336678192 |
---|---|
Provider Name | Mrs. Latoyia Cherdise Austin |
First Address | Crawfordsville, IN 47933 |
Second Address | Crawfordsville, IN 47933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2017 |
Last Update Date | 14/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
28151424A | (05) | IN |