Provider Demographics
NPI:1053178400
Name:HARRIS, LATRINA A (IBCLC)
Entity type:Individual
Prefix:
First Name:LATRINA
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:LATRINA
Other - Middle Name:
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25064 INDEPENDENCE DR APT 13301
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-1786
Mailing Address - Country:US
Mailing Address - Phone:586-354-3988
Mailing Address - Fax:
Practice Address - Street 1:25064 INDEPENDENCE DR APT 13301
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-1786
Practice Address - Country:US
Practice Address - Phone:586-354-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
MIL-312606174N00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health Worker
No174N00000XOther Service ProvidersLactation Consultant, Non-RN