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General NPI Number Information
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NPI Number | 1558483727
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Entity Type | Individual
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Provider Name | CAROLYN LOUISE LATHAN LPN
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Gender | Female
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7020 36TH AVE
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City | KENOSHA
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State | WI
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Zip | 53142-3947
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Country | US
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Telephone | 262-652-1001
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Fax |
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Provider Business Mailing Address
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Address Line | 7020 36TH AVE
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City | KENOSHA
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State | WI
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Zip | 53142-3947
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Country | US
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Telephone | 262-652-1001
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 21256031
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License Number State | WI
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