Healthcare Provider Details

I. General information

NPI: 1346105475
Provider Name (Legal Business Name): ERICK RAINER LATTEIER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5953 SWEET GUM DR
WILMINGTON NC
28409-2439
US

IV. Provider business mailing address

5953 SWEET GUM DR
WILMINGTON NC
28409-2439
US

V. Phone/Fax

Practice location:
  • Phone: 631-767-9095
  • Fax:
Mailing address:
  • Phone: 631-767-9095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5024692
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10250858
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: