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General NPI Number Information
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NPI Number | 1356359889
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Entity Type | Individual
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Provider Name | KIM MARIE LATTERNER PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 115 HICKORY DR
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City | MANCHESTER
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State | PA
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Zip | 17345-9502
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Country | US
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Telephone | 717-266-6784
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Fax |
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Provider Business Mailing Address
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Address Line | 115 HICKORY DR
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City | MANCHESTER
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State | PA
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Zip | 17345-9502
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Country | US
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Telephone | 717-266-6784
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0002815
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA001899L
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License Number State | PA
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