Healthcare Provider Details

I. General information

NPI: 1215309802
Provider Name (Legal Business Name): THERESA LATORRE-TEGTMEIER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 02/23/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S STATE ST STE 107
DOVER DE
19901-3562
US

IV. Provider business mailing address

640 S STATE ST MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-608-5299
  • Fax: 302-608-3885
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000895
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: