Healthcare Provider Details

I. General information

NPI: 1689287781
Provider Name (Legal Business Name): JENNIFER LATTERI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 EVERGREEN DR STE 20
GLEN MILLS PA
19342-1032
US

IV. Provider business mailing address

534 STAFFORD AVE
NEWARK DE
19711-5577
US

V. Phone/Fax

Practice location:
  • Phone: 484-785-3376
  • Fax: 610-358-6913
Mailing address:
  • Phone: 484-785-3376
  • Fax: 610-358-6193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA068007
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: