Healthcare Provider Details

I. General information

NPI: 1467364042
Provider Name (Legal Business Name): MORGAN MIA LATORRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

27820 LAUREN ST S
HARRISON TOWNSHIP MI
48045-6323
US

V. Phone/Fax

Practice location:
  • Phone: 313-833-4490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704392400
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: