Healthcare Provider Details

I. General information

NPI: 1811097058
Provider Name (Legal Business Name): JAIN A LATTES CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 SPRING ST
FLORENCE MA
01062-1261
US

IV. Provider business mailing address

45 SPRING ST
FLORENCE MA
01062-1261
US

V. Phone/Fax

Practice location:
  • Phone: 413-570-3088
  • Fax: 413-228-3884
Mailing address:
  • Phone: 413-570-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN255831
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number255831
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: