MS. LATEISHA NICOLE FORT


Address: 1222 E 170th St, South Holland, IL 60473-3558
Phone: 7086686971

MS. LATEISHA NICOLE FORT (NPI# 1275024523) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1275024523
Entity Type Individual
Full Name MS. LATEISHA NICOLE FORT
Credential APN
Practice Address 1222 E 170th St
South Holland
IL 60473-3558
Practice Telephone 7086686971
Mailing Telephone 7086686971
Enumeration Date 2018-05-22
Last Update Date 2018-05-22
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LA2100X Nurse Practitioner
Specialization: Acute Care
209017544 IL Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 1222 E 170TH ST
City SOUTH HOLLAND
State IL
Zip Code 60473-3558

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Taxonomy Information

Taxonomy Code 363LA2100X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Acute Care

Taxonomy Definition

Definition to come...

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Competitor

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City SOUTH HOLLAND
Zip Code 60473

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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