National Provider Identifier
Latisa L Roosevelt, RN
Latisa L Roosevelt, RN is listed in the NPPES registry with a primary specialty of Registered Nurse in Buffalo, NY and a listed phone number of (716) 816-2272.
Profile Overview
- NPI
- 1174822209
- Provider Type
- Individual
- Primary Specialty
- Registered Nurse
- Enumeration Date
- March 15, 2011
- Last Updated
- August 20, 2025
Practice Location
- 400 Forest Ave
- Buffalo, NY 14213-1207
Phone: (716) 816-2272
Mailing Address
- 37 Freeman St
- Buffalo, NY 14215-2704
Specialties
- Registered Nurse (163W00000X)
Full Record
- NPI
- 1174822209
- Entity Type
- Individual
- Last Name
- Roosevelt
- First Name
- Latisa
- Middle Name
- L
- Name Prefix
- MS.
- Credential
- RN
- Provider Other Last Name
- Roosevelt
- Provider Other First Name
- Latisa
- Provider Other Middle Name
- L
- Provider Other Name Prefix Text
- MS.
- Provider Other Credential Text
- RN
- Provider Other Last Name Type Code
- 2
- Mailing Street Address
- 37 Freeman St
- Mailing City
- Buffalo
- Mailing State
- NY
- Mailing ZIP Code
- 14215-2704
- Mailing Country
- US
- Mailing Phone
- (716) 931-3740
- Practice Street Address
- 400 Forest Ave
- Practice City
- Buffalo
- Practice State
- NY
- Practice ZIP Code
- 14213-1207
- Practice Country
- US
- Practice Phone
- (716) 816-2272
- Enumeration Date
- March 15, 2011
- Last Updated
- August 20, 2025
- Sex
- Female
- Sole Proprietor
- No
- Certification Date
- August 20, 2025
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Registered Nurse (163W00000X)