Healthcare Provider Details

I. General information

NPI: 1649826827
Provider Name (Legal Business Name): ELIZABETH ANN LATTIMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 SAND MINE RD
BERKELEY SPRINGS WV
25411-7457
US

IV. Provider business mailing address

32 LUCY LN
BERKELEY SPRINGS WV
25411-4892
US

V. Phone/Fax

Practice location:
  • Phone: 304-258-3096
  • Fax:
Mailing address:
  • Phone: 240-738-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: