Healthcare Provider Details

I. General information

NPI: 1154499390
Provider Name (Legal Business Name): MICHELLE A. LATIMER N.P.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 INWOOD AVE
BRONX NY
10452-2001
US

IV. Provider business mailing address

73 COOPER ST #3B
NEW YORK NY
10034-3070
US

V. Phone/Fax

Practice location:
  • Phone: 718-299-5500
  • Fax: 718-299-7679
Mailing address:
  • Phone: 646-873-0621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number400934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: