Healthcare Provider Details

I. General information

NPI: 1861968166
Provider Name (Legal Business Name): CAITLIN MARIE LATTA CNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SMITH AVE N
SAINT PAUL MN
55102-2346
US

IV. Provider business mailing address

600 N 2ND ST APT 112
MINNEAPOLIS MN
55401-3336
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6000
  • Fax:
Mailing address:
  • Phone: 612-419-8916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number2030515
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: