Healthcare Provider Details

I. General information

NPI: 1245579820
Provider Name (Legal Business Name): EMILY CECELIA LATIOLAIS NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 E PRESIDENT GEORGE BUSH HWY
RICHARDSON TX
75082-3542
US

IV. Provider business mailing address

1132 NIGHTHAWK RD
FORT WORTH TX
76108-6985
US

V. Phone/Fax

Practice location:
  • Phone: 214-343-6663
  • Fax:
Mailing address:
  • Phone: 337-302-2742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number747336
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: