Healthcare Provider Details

I. General information

NPI: 1477533610
Provider Name (Legal Business Name): MARYAM H LATEEF MHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8613 S 7TH DR
PHOENIX AZ
85041-8311
US

IV. Provider business mailing address

7219 S 15TH DR
PHOENIX AZ
85041-6930
US

V. Phone/Fax

Practice location:
  • Phone: 480-835-2371
  • Fax: 623-847-4047
Mailing address:
  • Phone: 602-403-5050
  • Fax: 623-777-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP 1782
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: