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General NPI Number Information
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NPI Number | 1720769953
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Entity Type | Individual
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Provider Name | LATIEMA MERILUS NP
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Gender | Female
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 6 WESMONT DR
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City | WOOD RIDGE
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State | NJ
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Zip | 07075-2152
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Country | US
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Telephone | 201-500-6992
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Fax | 833-605-4359
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Provider Business Mailing Address
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Address Line | 99 WALL ST STE 1571
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City | NEW YORK
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State | NY
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Zip | 10005-4301
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Country | US
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Telephone | 646-420-7824
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 405146
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ14918600
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License Number State | NJ
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