NPI | 1689660425 |
---|---|
Former Name | TINA M LATTA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71003623A) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704205664) |
Enumeration Date | 2005-09-27 |
Last Update Date | 2023-03-13 |