Provider Demographics
NPI:1043092943
Name:BETHEA, LATRESE
Entity type:Individual
Prefix:
First Name:LATRESE
Middle Name:
Last Name:BETHEA
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 1:1015 WAHLER PL SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4332
Mailing Address - Country:US
Mailing Address - Phone:240-370-0485
Mailing Address - Fax:
Practice Address - Street 1:950 MAINE AVE SW APT E722
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3447
Practice Address - Country:US
Practice Address - Phone:202-706-9656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health