Healthcare Provider Details

I. General information

NPI: 1255884961
Provider Name (Legal Business Name): LARA LATTMAN CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LARA HENNESSEY CNS, LDN

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 CAWLEY DR
FREDERICK MD
21703-4563
US

IV. Provider business mailing address

637 CAWLEY DR
FREDERICK MD
21703-4563
US

V. Phone/Fax

Practice location:
  • Phone: 301-518-5414
  • Fax:
Mailing address:
  • Phone: 301-518-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX3792
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: