Healthcare Provider Details

I. General information

NPI: 1639213549
Provider Name (Legal Business Name): JUDY LATTANZI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TYRE AVE
NEWARK DE
19711-7136
US

IV. Provider business mailing address

200 TYRE AVE
NEWARK DE
19711-7136
US

V. Phone/Fax

Practice location:
  • Phone: 302-454-2047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberL10015355
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: