Provider Demographics
NPI:1679324255
Name:NELMS-TUCKER, LATISHA
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:
Last Name:NELMS-TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S BOULDER HWY APT 6207
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-8537
Mailing Address - Country:US
Mailing Address - Phone:725-242-1361
Mailing Address - Fax:
Practice Address - Street 1:1601 S BOULDER HWY APT 6207
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-8537
Practice Address - Country:US
Practice Address - Phone:725-242-1361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver