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General NPI Number Information
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NPI Number | 1235481458
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Entity Type | Individual
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Provider Name | LEA LATHAM CRNP
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Gender | Female
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 1215 N BEAVER ST STE 203
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3120
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Country | US
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Telephone | 928-773-2200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33269
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City | PHOENIX
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State | AZ
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Zip | 85067-3269
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Country | US
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Telephone | 602-406-4786
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Fax | 916-636-4358
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP4386
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License Number State | AZ
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