Healthcare Provider Details

I. General information

NPI: 1841528908
Provider Name (Legal Business Name): ELLEN ANN LATOUR RN/NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 10/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 CHESTNUT ST SUITE 23
SPRINGFIELD MA
01107-1637
US

IV. Provider business mailing address

780 CHESTNUT ST SUITE 23
SPRINGFIELD MA
01107-1637
US

V. Phone/Fax

Practice location:
  • Phone: 413-787-2800
  • Fax: 413-787-2822
Mailing address:
  • Phone: 413-787-2800
  • Fax: 413-787-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN160329
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN160329
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: