Healthcare Provider Details

I. General information

NPI: 1902796618
Provider Name (Legal Business Name): SHERRI LYNN LATTIBEAUDEIR DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2025
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MEMORIAL DR
JACKSONVILLE NC
28546-6333
US

IV. Provider business mailing address

200 CYPRESS BAY DR
JACKSONVILLE NC
28546-8659
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-4333
  • Fax:
Mailing address:
  • Phone: 305-725-1165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM986
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: