1962855353 NPI number — MRS. LATOYA ROSELLE FRANKLIN CM

Table of content: MRS. LATOYA ROSELLE FRANKLIN CM (NPI 1962855353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962855353 NPI number — MRS. LATOYA ROSELLE FRANKLIN CM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRANKLIN
Provider First Name:
LATOYA
Provider Middle Name:
ROSELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRANKLIN
Provider Other First Name:
TOYA
Provider Other Middle Name:
ROSELLE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1962855353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14741 AGNES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTPOINTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48021-2881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-222-5196
Provider Business Mailing Address Fax Number:
586-408-6000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23705 SHAKESPEARE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTPOINTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48021-1719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-222-5196
Provider Business Practice Location Address Fax Number:
586-349-6008
Provider Enumeration Date:
07/20/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X , with the licence number:  19167684 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)