Healthcare Provider Details

I. General information

NPI: 1386372274
Provider Name (Legal Business Name): CLAIRE LATOURETTE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PATERSON ST # 3100
NEW BRUNSWICK NJ
08901-1962
US

IV. Provider business mailing address

12 MICHELE TER
SUCCASUNNA NJ
07876-1034
US

V. Phone/Fax

Practice location:
  • Phone: 732-937-8841
  • Fax:
Mailing address:
  • Phone: 908-763-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ01347100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: