Active NPI
Latia Marie Wallace, LPN
- Licensed Practical Nurse
- Aurora, OH
National Provider Identifier
1962194506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 180564
- Practice address
- 134 Ashland LN
Aurora, OH 44202-8877 - Phone
- (440) 665-1662
- NPI assigned
- May 23, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 180564 | OH | Primary |
Addresses
Primary practice location
134 Ashland LN
Aurora, OH 44202-8877
Mailing address
134 Ashland LN
Aurora, OH 44202-8877
Phone (440) 665-1662
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180564 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684800000000",
"number": "1962194506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "134 ASHLAND LN",
"city": "AURORA",
"state": "OH",
"postal_code": "442028877",
"telephone_number": "440-665-1662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "134 ASHLAND LN",
"city": "AURORA",
"state": "OH",
"postal_code": "442028877",
"telephone_number": "440-665-1662"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "LATIA",
"middle_name": "MARIE",
"name_prefix": "Miss",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-05-23",
"last_updated": "2023-05-23",
"certification_date": "2023-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "180564",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aurora, OH
- Diana Vasylkevych, DDS
- Jerome Richard Vidd, DO
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3250)
- Wal-Mart Stores East, LP (Wal-Mart Vision Center 30-3250)
- Walgreen Co (Walgreens #10567)
- Barbara Washington, LPN
- Rebecca Waud, OTR/L
- Vicki Lynn Webster
- Reid Michael Wenger, DDS, MSD
- Steven J Wentz, DPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.