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General NPI Number Information
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NPI Number | 1417419045
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Entity Type | Individual
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Provider Name | LATIFA OMRAN
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Gender | Female
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 1400 W PARK ST
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City | URBANA
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State | IL
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Zip | 61801-2334
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Country | US
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Telephone | 217-337-2322
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Fax |
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Provider Business Mailing Address
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Address Line | 3103 SANDHILL LN
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City | CHAMPAIGN
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State | IL
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Zip | 61822-6180
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Country | US
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Telephone | 217-721-5278
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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 | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State |
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