Healthcare Provider Details

I. General information

NPI: 1346354503
Provider Name (Legal Business Name): NANCY LATAITIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9785 MAROON CIR STE G104
ENGLEWOOD CO
80112-5922
US

IV. Provider business mailing address

PO BOX 17982
BELFAST ME
04915
US

V. Phone/Fax

Practice location:
  • Phone: 303-779-1172
  • Fax:
Mailing address:
  • Phone: 303-388-4256
  • Fax: 303-388-7802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0027713
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: