Provider Demographics
NPI:1447629803
Name:MOZEE, LATASHIA (CNA)
Entity type:Individual
Prefix:MRS
First Name:LATASHIA
Middle Name:
Last Name:MOZEE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 HAWTHORNE AVE
Mailing Address - Street 2:1
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-1336
Mailing Address - Country:US
Mailing Address - Phone:973-900-0938
Mailing Address - Fax:973-991-0774
Practice Address - Street 1:514 HAWTHORNE AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-1336
Practice Address - Country:US
Practice Address - Phone:973-489-6961
Practice Address - Fax:973-991-0774
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNA200016172376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNA200016172OtherCERTIFIED NURSING ASSISTANCE