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General NPI Number Information
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NPI Number | 1487017125
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Entity Type | Individual
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Provider Name | LATEEFA ANTROM CRNP
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Gender | Female
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 1427 HORSHAM RD
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City | NORTH WALES
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State | PA
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Zip | 19454-1320
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Country | US
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Telephone | 215-326-9065
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Fax | 215-703-9776
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Provider Business Mailing Address
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Address Line | 1616 ROSE LN
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City | NORTH WALES
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State | PA
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Zip | 19454-3623
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Country | US
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Telephone | 610-506-8509
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP015881
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License Number State | PA
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