Basic Information
| Provider Information | |||||||||
| NPI: | 1093074197 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRATHWAITE | ||||||||
| FirstName: | LATOYA | ||||||||
| MiddleName: | LABRESSKA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636256 | ||||||||
| Address2: | CENTRAL CREDENTIALING | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452636256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135855504 | ||||||||
| FaxNumber: | 5135855511 | ||||||||
| Practice Location | |||||||||
| Address1: | 3130 HIGHLAND AVE | ||||||||
| Address2: | 2ND FLOOR NEPHROLOGY HOXWORTH CLINIC | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135844061 | ||||||||
| FaxNumber: | 5135843349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2012 | ||||||||
| LastUpdateDate: | 08/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 57.021384 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 57.021384 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 35131976 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.