Latanya Olivia Edenburgs
Individual provider Active NPI Case Manager/Care Coordinator · Mesa, AZ
NPI 1033623541 · NPPES record last updated Nov 20, 2017
Key facts
- NPI
- 1033623541
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Case Manager/Care Coordinator 171M00000X
- Practice address
- 10436 E Radiant Ave.
Mesa, AZ 85212 - Phone
- (480) 560-2305
- NPI assigned
- Nov 20, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Yes |
Addresses
Primary practice location
10436 E Radiant Ave.
Mesa, AZ 85212
Mailing address
10436 E Radiant Ave
Mesa, AZ 85212-8099
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2675131 | Medicaid | AZ |
Other providers in Mesa, AZ
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- Angela Edelbrock
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- Gary W Eden
- Vicki Louise Eden
- Pamela Lea Edens
- Kayla May Edgar
- Edgeline Audiology PLLC
- Edkey,Inc
- Anngela Park Edkins
All providers in Mesa, AZ · Case Manager/Care Coordinator in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.