Healthcare Provider Details

I. General information

NPI: 1174030811
Provider Name (Legal Business Name): CHRISTINA MICHELLE LATTNER DNP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 W CHICAGO AVE
CHICAGO IL
60642-5236
US

IV. Provider business mailing address

9119 S EXCHANGE AVE
CHICAGO IL
60617-4225
US

V. Phone/Fax

Practice location:
  • Phone: 773-423-6400
  • Fax:
Mailing address:
  • Phone: 773-768-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number209.014245
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: